Legislature(2021 - 2022)BUTROVICH 205
03/18/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB89 | |
| SB98 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 89 | TELECONFERENCED | |
| *+ | SB 98 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 18, 2021
1:32 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair (via teleconference)
Senator Shelley Hughes, Vice Chair
Senator Mia Costello
Senator Lora Reinbold
Senator Tom Begich
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
SENATE BILL NO. 89
"An Act relating to house rules for assisted living homes."
- HEARD AND HELD
SENATE BILL NO. 98
"An Act relating to medical assistance for recipients of adult
foster care services; establishing an adult foster care home
license and procedures; and providing for the transition of
individuals from foster care to adult foster care homes."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 89
SHORT TITLE: ASSISTED LIVING HOMES: HOUSE RULES
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
02/22/21 (S) READ THE FIRST TIME - REFERRALS
02/22/21 (S) HSS, FIN
03/18/21 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 98
SHORT TITLE: ADULT FOSTER CARE FOR DISABLED
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
03/03/21 (S) READ THE FIRST TIME - REFERRALS
03/03/21 (S) HSS, FIN
03/18/21 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
JOHN LEE, Director
Division of Senior and Disabilities Services
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Presented SB 89 on behalf of the Senate
Rules Committee by request of the governor
TONY NEWMAN, Deputy Director
Division of Senior and Disabilities Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions about SB 89.
LYNNE KEILMAN-CRUZ, Chief of Quality
Division of Senior and Disabilities Services
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Answered questions about SB 89.
CRAIG BRAXTER, Program Manager
Residential Licensing
Health Care Services
Department of Health and Social Services (DHSS)
Anchorage, Alaska*
POSITION STATEMENT: Answered questions about SB 89.
ROBIN MINARD, Chief Communications Officer
Mat-Su Health Foundation
Wasilla, Alaska
POSITION STATEMENT: Testified in support of SB 89.
JOHN LEE, Director
Division of Senior and Disabilities Services
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Introduced SB 98 on behalf of the Senate
Rules Committee by request of the governor.
TONY NEWMAN, Deputy Director
Division of Senior and Disabilities Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Presented SB 98 on behalf of the Senate
Rules Committee by request of the governor.
CHRISSY VOGELEY, Community Relations Manager
Office of Children's Services
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: During the course of the hearing on SB 98
provided information about foster care stipends.
LOIS EPPERSON, representing self
Wasilla, Alaska
POSITION STATEMENT: Testified in favor of SB 98.
LINDA GIANI, representing self
Wasilla, Alaska
POSITION STATEMENT: Testified in favor of SB 98.
ACTION NARRATIVE
1:32:15 PM
VICE CHAIR SHELLEY HUGHES 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 Costello, Begich,
Reinbold, Chair Wilson via teleconference, and Vice Chair
Hughes.
SB 89-ASSISTED LIVING HOMES: HOUSE RULES
1:32:48 PM
VICE CHAIR HUGHES announced the consideration of SENATE BILL NO.
89 "An Act relating to house rules for assisted living homes."
intent to hear an overview and take testimony. She called on
Director John Lee to testify.
1:34:11 PM
JOHN LEE, Director, Division of Senior and Disabilities
Services, Department of Health and Social Services (DHSS),
Palmer, Alaska, asked his team to introduce themselves.
MR.LEE said that SB 89 deals with assisted living homes, home
and community-based services. In Alaska these are 1915(c) waiver
services. That means that Alaska gets a federal match of 50
percent for the waiver programs. The waiver programs offer
optional, low-cost home and community-based options for people
who would otherwise be in institutions. These programs provide
services that keep people in their communities and keep costs
low.
1:36:24 PM
MR. LEE said that Alaska statutes are not in compliance with
federal regulations that require home and community-based
service providers to give people who are on waivers the same
access to community as people not on waivers. For example, the
state law allows assisted living homes to establish house rules
around visitations, but the federal statutes require that these
providers allow individuals to exercise the same choices and
options as if they were in their own homes. This bill makes a
couple of statutory changes so the state can be in compliance
with the final rule of federal codes that govern these programs.
Ongoing participation in the waiver depends on the state being
compliant. The federal government has given states until 2023 to
make the statutory changes to be in compliance with the final
rules.
MR. LEE said that the simple insertion of language into the
assisted living home statute will bring the state into
compliance with the Centers for Medicaid and Medicare Services
(CMS) home and community-based setting requirements. The bill
would ensure that recipients of waiver services will be able to
live under conditions as much like a person's home as possible.
About 700 assisted living home providers in state will be
required to abide by the conditions defined in the bill. This
new statutory language will afford all residents living in
assisted living homes the same rights, regardless of whether the
home accepts Medicaid for payment or not. There are 650 homes
already in compliance with the conditions set forth in this
legislation. The states have until March of 2023 to comply with
this rule. That was an extension of the timeline. Because of the
pandemic, CMS gave states additional time to comply. There is no
fiscal impact from the bill.
MR. LEE presented the sectional:
Section 1: Amends AS 47.33.060 House Rules for
Assisted Living Homes to explicitly require
consistency with federal regulation when house rules
are established.
Section 2: Adds a new section to AS 47.33.060 House
Rules for Assisted Living Homes to make explicit that
assisted living homes that provide waiver services may
not adopt house rules inconsistent with federal
regulations.
Section 3: Carries the statutory amendments proposed
in Section 1 and Section 2 of the bill to AS
47.33.300(a) regarding a resident's rights to have
visitors.
1:40:02 PM
SENATOR COSTELLO said that a number of individuals in Alaska in
assisted living homes and community-based homes have a high
percentage who experience early onset of dementia or are
somewhere on the spectrum of dementia. When she looks at the
highlighted portion of the bill that says individuals can have
visitors of their choosing at any time, she wonders whether
people who have power of attorney or family members overseeing
their matters can determine who the visitors are.
MR. LEE answered that if individuals have guardians, the
guardians do have the ability to make choices on behalf of the
individual. One of the responsibilities of the guardian is to
make decisions as close to what those individuals would make on
their own.
SENATOR BEGICH asked if Section 4 is still required, which has
provisional language relating to the executive orders submitted
by the governor to the 32nd Alaska State Legislature in the
first regular session. Since that has been withdrawn, he asked
whether Section 4 should be eliminated.
MR. LEE deferred to Tony Newman.
1:42:08 PM
TONY NEWMAN, Deputy Director, Division of Senior and
Disabilities Services, Department of Health and Social Services
(DHSS), Juneau, Alaska, said that Section 4 could be eliminated,
but the division would need to defer to the Department of Law.
SENATOR BEGICH explained that he is not intending to slow the
bill. He is just bringing that to the attention of the author.
That could be removed later in the process if it is no longer
relevant.
VICE CHAIR HUGHES said an order may be reissued if the
legislature did not reconvene. Mr. Lee might want to make sure
that it would suit that possible future scenario.
SENATOR BEGICH said he received a legal opinion on the order.
Unless it is issued tomorrow, there will be no ability in the
first regular session for there to be a regular order. At this
point, if it is left in it would be irrelevant. He doesn't know
the answer. He doesn't want to hold the bill up for that but is
bringing it to the attention of the bill's author.
VICE CHAIR HUGHES said that if the words "in the first regular
session" would be removed it would be possible an order could be
reissued and if the legislature decided not to convene and stop
it, it would be applicable. She leaves it to Mr. Lee.
SENATOR WILSON asked what the consequences are for the providers
who are not in compliance with the new guidelines.
MR. LEE explained that once the statute goes into effect,
licensed providers will need to be in compliance.
1:45:06 PM
CRAIG BRAXTER, Program Manager, Residential Licensing, Health
Care Services, Department of Health and Social Services (DHSS),
Anchorage, Alaska said that the residential licensing agency
would reach out to those providers and have them update those
house rules to reflect the change. Of the 50 or so providers who
are not currently certified, as new licensees their house rules
would now have to reflect the visitation requirements if
certified. A fair number of the 50 providers are provisionally
licensed and are in the process of seeking certification. It is
probably even fewer than 50 who would be affected. The handful
that would not be affected are the ones who have opted not to be
certified or who have lost certification. They essentially just
have to expand visitation hours. Most facilities have visitation
hours usually between 8 to 8. They would need to update those
visitation hours.
SENATOR WILSON asked what the penalty is if they don't do this
or if they aren't notified or fall through the cracks.
MR. BAXTER replied that if they refuse to update their house
rules, probably the first time someone had a visitor barred the
agency would intervene and notify them of noncompliance and then
ask for a plan of correction and try to resolve that with the
facility. If the facility continued to not allow visitation in
compliance with those rules, then the agency may issue a warning
notice or elevate it to a higher enforcement action. They do try
to work with a facility to come into compliance. If someone
filed an appeal, the agency goes through the administrative
appeals process to resolve the issue as well.
1:47:22 PM
SENATOR COSTELLO noted that many assisted living homes were not
able to accept visitors because of COVID. She asked if this is
in response to that or is that a separate issue entirely.
MR. LEE answered that is a common question. This statute is
needed regardless of COVID. COVID has nothing to do with this
bill except that during COVID certain regulations were able to
be suspended. The bill is needed to be in compliance with the
code of federal regulations.
SENATOR COSTELLO asked how many complaints are received from
individuals or families in homes and what agency deals with
those complaints.
MR. LEE responded that it depends on the complaint. If it is
about a program that Senior Disability Services provides, then
the complaints will come to Senior Disability Services.
Licensing complaints about providers could go to Craig Baxter.
The recipient community is in favor of this bill, to make sure
providers and the state allow people to live their lives as they
choose. This will be well received by the recipient community.
There are already more than 650 providers out of 700 in
compliance.
SENATOR COSTELLO said that her questions are not directly
related to the bill. She asked if the division requires a survey
of residents' families.
MR. LEE said the division partners with providers and recipients
frequently. He deferred to Ms. Keilman-Cruz.
1:51:52 PM
LYNNE KEILMAN-CRUZ, Chief of Quality, Division of Senior and
Disabilities Services, Department of Health and Social Services
(DHSS), Anchorage, Alaska, replied that Senior Disabilities has
a central reporting intake. Individuals and families can make
complaints that are then routed to each of the oversight
divisions, such as residential licensing and the quality
assurance program. The division does not do surveys but does
require homes or entities with certifications to conduct their
own satisfaction surveys and report those to the division.
SENATOR COSTELLO said that was her question. The surveys are
done and the results are provided to Ms. Keilman-Cruz's office.
She asked if the results are public.
MS. KEILMAN-CRUZ answered they are not typically public. The
division uses them as a quality overview of how the providers
are doing. They conduct their own internal surveys. Until a
complaint is completely adjudicated, the division would not
release those complaints.
SENATOR COSTELLO asked if Ms. Keilman-Cruz' agency can provide
information on complaints that have been finalized so that the
public officials can have sense of a nature of the situation in
Alaska. The state has one of the fastest growing senior
populations. It would be interesting for the committee to know
the nature of some of the complaints after the past five years.
MS. KEILMAN-CRUZ said the division could give an overview of the
types and amounts of complaints and Craig Baxter can discuss the
licensing inspection and investigation process.
1:55:20 PM
VICE CHAIR HUGHES asked her to provide that to Senator Wilson's
office. She has general questions, like Senator Costello, to
help the committee be informed about assisted living homes. She
asked if a person is looking for a home for loved one, is there
a resource to look at ratings or a way to evaluate assisted
living homes.
MR. LEE replied that are not a lot of online ratings for
assisted living facilities. One of things his division provides
for individuals who qualify for the waiver program is a way to
connect them with care coordinators who are charged with helping
individuals navigate their options and help them evaluate the
quality of care of facilities they may be placed in.
MR. BAXTER said that his office conducts between 500-600
inspections annually and 300-400 investigations annually. Once
those reports become public, any member of the public can reach
out to his office for copies of reports or surveys. His office
has a list of licensed providers on its website. There are a
handful of agencies that some facilities are associated with,
like A Place for Mom. Those agencies request routine inspection
reports from his office so they can make sure their recommended
facilities are in compliance. Outside of that there is no rating
system that the state or anyone else publishes for all the
assisted living homes.
SENATOR HUGHES asked if 700 providers are adequate for the
growing senior population.
MR. LEE answered that to be 100 percent honest, it depends on
where someone lives. In Anchorage, Mat-Su, Fairbanks, and the
larger areas, there is an adequate supply. The real issue is the
more remote populations. It depends on where someone lives.
1:59:59 PM
MR. NEWMAN said that to his knowledge no analysis has been done
recently that demonstrates either a surplus or a shortage in
Alaska, but they know that Alaska does have the fastest growing
senior population in the country. The number of licensed
assisting homes in Alaska has been growing dramatically. The
stakeholders would probably say Alaska could always use more
assisted living homes that are well tailored to meet the needs
of varied clients.
VICE CHAIR HUGHES noted there is a Pioneer Home in her district
and the residents suffered from loneliness and the home tried to
make better arrangements for visits during the high point of the
pandemic as the homes were trying to protect that population.
She asked if assisted living homes had similar strict rules as
far as visitation.
MR. BAXTER answered that the Pioneer Homes are licensed in the
same way as the rest are. The same guidelines and health orders
applied to all.
VICE CHAIR HUGHES said that to come into compliance with federal
law, her understanding is that assisted living homes would need
allow visitors at any time. Mr. Baxter had mentioned that some
had visiting hours from 8 a.m. to 8 p.m. She asked if assisted
living homes must accept visitors 24/7 now.
MR. LEE said that the statute will require that the individuals
have opportunities to have visitors at the time of their
choosing, so yes.
VICE CHAIR HUGHES said that the state must be in compliance
March 2023 and about 50 homes that still need to come into
compliance. She asked if they will be relicensed before March
2023, so will that occur naturally.
2:03:27 PM
MR. BAXTER answered that will happen naturally. The majority of
licenses are biennial, a two-year cycle. Most new homes are
provisionally licensed on a one-year cycle. It would be easy for
the division to do it as part of the natural licensing cycle by
2023. If a home was not able to be in compliance by that time,
the division will reach out to the home to work on that.
SENATOR COSTELLO asked if the bill addresses online visits.
MR. LEE said that is an excellent question in light of the
pandemic value of distance delivery.
MR. BAXTER replied that residents already have the right under
AS 47.33.300 to engage in private communication, telephonically,
in person, or using the internet. That cannot be restricted by a
facility. If a facility were restricting someone's ability to
get online and contact people, that would be an issue unless a
guardian had restricted that.
SENATOR COSTELLO said she is not thinking of a facility
restricting that but more in terms of the facility providing the
opportunities. She asked if visitors include online visitors and
if the resident doesn't own a device, does the legislation
require the facilities to provide the opportunity.
MR. LEE answered that the final rule does not direct states to
have that requirement. The proposed bill does not require the
provider to provide that. There are resources to help people get
devices, but the bill is silent on that. The attempt with the
bill is for the state to be compliant with the final rules
without adding any additional requirements.
SENATOR COSTELLO clarified that her line of inquiry is about the
definition of visitor. She is hearing that it is an in-person
visitor and not an electronic visit. That is how she read the
bill, but she thought it worth bringing up because many
individuals do not have family here in Alaska and it would be
nice for that opportunity to be provided to residents.
VICE CHAIR HUGHES shared that she knows the facility in Juneau
was accommodating during her father's final weeks with visits
through phones or tablets during the pandemic.
2:08:39 PM
SENATOR WILSON asked knowing that assisted living providers have
a lot of issues with billing Medicaid, if the department
provides technical assistant for that. Medicaid audits are high
for assisted living facilities.
MS. KEILMAN-CRUZ answered that her agency supplies lots of
technical assistance and has an open door policy for facilities
to ask questions through the provider certification and
compliance unit. When her agency does investigations, many times
it is offering technical assistance to come into compliance.
Residential licensing supplies the same sort of technical
assistance. For billing specifically, there are online programs
and trainings to assist with billing.
MR. BAXTER said his agency also offers a variety of training
opportunities to new and existing facilities regarding licensing
complaints. It does not deal with Medicaid billing but with
compliance and standards. Providers can reach out to his agency
for help.
VICE CHAIR HUGHES noted there is no fiscal note and asked if
there is potential for increased staffing if there are more
visitors in an assisted living home or will that be minimal.
MR. BAXTER replied his office already works closely with Senior
and Disabilities Services to bring the 650 homes into compliance
and he has not noted any increase in staffing because of this.
2:12:32 PM
VICE CHAIR HUGHES opened public testimony.
2:12:46 PM
ROBIN MINARD, Chief Communication Officer, Mat-Su Health
Foundation, Wasilla, Alaska, said that currently Alaska allows
assisted living to establish house rules for visitors. While the
state law says the house rules may not be unreasonably
restrictive, the federal regulation is more explicit, stating
that individuals on waivers must be able to have visitors of
their choosing at any time. The Mat-Su Health Foundation
supports this change because it affords residents of assisted
living homes the ability to make decisions for themselves.
Alaskans in these settings deserve living conditions as close as
possible to those they would have in their own homes. Mat-Su has
the fastest growing senior population in the state. By 2030 more
than one in five Mat-Su residents will age 60 or older and those
over age 85 will increase by 188 percent. These residents are
often the most vulnerable and require more intense services. She
urged the committee to pass SB 89 so the most vulnerable and
most treasured citizens can enjoy the living conditions they
deserve.
2:14:57 PM
VICE CHAIR HUGHES closed public testimony and noted the written
testimony that had been submitted in support of the bill. She
held SB 89 in committee.
SB 98-ADULT FOSTER CARE FOR DISABLED
2:15:43 PM
VICE CHAIR HUGHES announced the consideration of SENATE BILL NO.
98 "An Act relating to medical assistance for recipients of
adult foster care services; establishing an adult foster care
home license and procedures; and providing for the transition of
individuals from foster care to adult foster care homes." She
stated her intent to hear an overview of the bill, a sectional
analysis, and testimony on the bill.
2:16:51 PM
At ease
2:22:48 PM
VICE CHAIR HUGHES reconvened the meeting.
2:22:50 PM
JOHN LEE, Director, Division of Senior and Disabilities
Services, Department of Health and Social Services (DHSS),
Palmer, Alaska, turned to Tony Newman to give the presentation
on SB 98.
2:23:29 PM
TONY NEWMAN, Deputy Director, Division of Senior and
Disabilities Services, Department of Health and Social Services
(DHSS), Juneau, Alaska, said he first wanted to describe the
type of person this bill is meant to serve. This individual may
have started life with a disability due to a range of
conditions, from autism to Down syndrome, and sometimes with
even more complex and serious medical conditions, such as
cerebral palsy, cystic fibrosis, short gut syndrome, disorders
that could mean a lifetime of intensive medical treatments and
prolonged dependence on technology. Adding to their challenges,
these children are also in foster care because their parents are
unable or unwilling to give them the care that they need. At any
given time in Alaska, roughly 20-30 children are in state
custody with these types of disabilities. Thanks to the
wonderful people who serve as foster parents in the state and
the state's waiver programs for people with disabilities, these
kids can enjoy a secure and safe life in a home sitting, not an
institution, surrounded by people who know and love them and are
often willing to care for them throughout their childhood. The
need for this bill arises because of changes that occur when a
child reaches adulthood. The foster parents are no longer able
to offer traditional foster care once the child ages out of
state custody. There are also some disincentives and obstacles
that make it difficult for the foster parents to transition to
some new type of caregiving arrangement, which in turn makes it
hard for that young person to stay with the same people, who may
be the only people they know. This may force the young person
into a new living situation that can be a traumatic change. It
may even require the young person to leave the home community.
2:25:38 PM
MR. NEWMAN said that constituents of then state Senator Dunleavy
brought these concerns to his attention. In 2017, Senator
Dunleavy introduced a bill, SB 10, that sought to address the
issue. That approach was still being refined when he left the
senate, but his interest in addressing the issue remained.
Several months ago he asked the department to find a
straightforward and as simple a way as possible for the foster
child and foster parents to remain together as a family when a
child becomes an adult, if they so choose.
MR. NEWMAN displayed a graphic titled Adult Foster Care for
Disabled to illustrate how the bill attempts to provide a
solution. The service structure at Senior Disabilities is fairly
complex, but the diagram gets to the heart of the matter well.
The diagram shows the typical current path for aging out of
foster care and the proposed path. A child in foster care in a
licensed child family home habilitation has a stipend of $157 a
day or a foster care stipend of about $70 a day for these types
of children and personal care services. An adult on a Medicaid
home and community-based waiver receives adult family home
habilitation at $126 a day with no personal care services in an
assisted home with a license with a menu of additional waiver
services. The proposed adult foster care would have stipend of
$115 a day and personal care services and would be in a licensed
adult foster home with a menu of additional waiver services.
Constituents have said that personal care services are valued by
foster parents because this can be some of the most exhausting
and challenging work in raising these kids.
2:29:23 PM
MR. NEWMAN said that the rate is reduced for children who go
from child home habilitation to adult family home habilitation.
They lose personal care services because greater independence
and self-care is assumed for the adult. The adult family home
habilitation is reduced because in adulthood they receive a
wider menu of waiver services to promote their independence.
Instead of a foster care license, if children remain in the same
home, the foster parents need an assisted living license, which
has considerably higher expectations for safety policies and
procedures and space requirements. To summarize, when children
become adults, the foster parents lose the foster care stipend.
The children have lost the ability to receive personal care
services, and foster parents would have to set up their homes to
meet the licensing requirements for an assisted living home.
While the young adult would have wider range of potential
services to draw from, if they have a severe medical condition,
their ability to take advantage of those services, like
transportation or employment services, may be limited. Foster
parents face high hurdles and difficult choices to maintain the
youth in their homes. There are other living arrangements and
approaches that the foster parents and the former foster
children can pursue to stay together. The foster parents could
increase the rates they receive by certifying as a group home,
but those other options have expectations and drawbacks that are
frequently less attractive.
MR. NEWMAN said that SB 98 makes it easier for the former foster
parents and foster children to stay together longer. Instead of
offering adult family home habilitation, foster parents can be
certified as adult foster parents and receive stipends with
lighter expectations around providing habilitative services, but
those pay more than a basic room-and-board style rate. Instead
of an assisted living home license, the department would create
a new adult foster care home license, with requirements that are
more akin to child foster home than assisted living home. The
menu of other services would still be available to those who
could benefit from them. Best of all will be the continuity of
care the bill will allow. Nobody would be forced into the new
arrangement. These other options would still be available, but
for those who want to stay together as a family, this could be
an attractive option.
2:31:46 PM
SENATOR BEGICH offered the clarification that he is seeing a
continuation. The department is trying to maintain a continuum
that respects the living arrangements that have worked for the
youth as they transition into adulthood. It is tempting to
receive a government block on the ability to do this. This is
good public policy to ensure continuum of care for those who are
less able to take care of themselves.
MR. NEWMAN replied that is a perfect summary of the bill.
SENATOR COSTELLO said she appreciates the bill. She has spoken
to many foster care youth. She asked if there is an issue where
one group of Alaskans is provided an opportunity and another
isn't. She could see that a lot of other foster care youth would
want to continue in their foster care home. She asked if there
is a path for them.
MR. LEE said he is engaged in dialogue with a consultant for the
Centers for Medicare and Medicaid Services (CMS) to make sure
that this will be a viable option to pursue and will receive
Medicaid funding. He asked her to repeat the second question.
SENATOR COSTELLO asked if there is a path forward if a family
wants to continue with aged-out foster youth.
MR. LEE answered if the children are not on a Senior and
Disabilities waiver and are solely receiving services as a
foster care youth, they become adults and they can make their
own decisions, of course, in conjunction with their former
foster care parents. He asked Chrissy Vogeley to offer more
insight on that.
2:35:02 PM
CHRISSY VOGELEY, Community Relations Manager, Office of
Children's Services, Department of Health and Social Services
(DHSS), Juneau, Alaska, said for youth not on waiver services,
they can continue to live with their foster parents if that is
agreeable to all.
SENATOR REINBOLD asked what the stipend rates are based on.
MR. LEE answered that the child family home habilitation $157 a
day rates are set by the division with help from the Office of
Rate Review. The $70 a day is an approximation for what a child
at this level of need would require. The Office of Children's
Services offers a foster care stipend that ranges from $30 to
over $100 a day, depending on the child's need, so it is
approximate $70 a day. The rate goes down to $126 a day for
family home habilitation because it is assumed that the adults
have a higher level of independence as adults. They also get a
menu of additional waiver services, such as help with meals and
transportation. That is why the rate goes down to $126 a day.
His office came up with the rate of $115 a day for the adult
foster care in consultation with partners. The office wanted to
find a rate that was not as high as adult family home
habilitation because there are fewer administrative
requirements. The office wanted this to be attractive for those
who want to pursue the adult foster care license without the
administrative burdens.
2:38:20 PM
SENATOR REINBOLD asked how the parents get this money and are
there any parameters about how to use the money.
MR. NEWMAN said his office will need regulations to work out the
details about the expectations about the level of care provided
by adult foster parents. It will be a lot like foster childcare.
His office will take the lead from the way the Office of
Children's Services provides payment to foster parents.
VICE CHAIR HUGHES asked Ms. Vogeley to also respond.
MS. VOGELEY said that foster care payments are paid monthly
directly to foster parents in a manner of their choosing.
SENATOR REINBOLD clarified the two options are direct deposit or
a check. She asked if it is a lump sum for the entire month.
MS. VOGELEY replied yes.
SENATOR REINBOLD asked what happens if the care is only two
weeks and a month's stipend has been deposited.
MS. VOGELEY answered that she believes payments are paid after
the month. There have been situations of overpayments and the
office requests the money to be returned.
SENATOR BEGICH offered that his sister was a foster parent and
was paid after the fact.
VICE CHAIR HUGHES asked how many disabled foster youth turn 18
each year.
MR. NEWMAN answered that it could range from none or 10 a year.
VICE CHAIR HUGHES asked what the range of disabilities
applicable for this situation is.
MR. LEE said the bill is talking about youth eligible for
waivers. This means that they have been assessed such that they
could receive care in an institution, an intermediate care
facility or a skilled nursing facility. These conditions include
severe cerebral palsy, short gut syndrome, Down syndrome, and
autism.
2:43:40 PM
VICE CHAIR HUGHES commented that it would be difficult for them
to live independently. She opened public testimony.
2:44:04 PM
LOIS EPPERSON, representing self, Wasilla, Alaska, said she has
been a foster childcare provider since the 90s for children on
waivers. She is licensed as an assisted living home because the
girl they have had in their home for 18 years aged out of child
foster care. In order to keep her in their home their option was
to become an assisted living home. They have taken care of three
children on waivers over the last 30 years until they moved out
or passed away. These are kids who are severely brain damaged
from birth trauma. The person they have now requires complete
total care. She cannot roll over on her own. She must be fed and
bathed. This is the type of child who would benefit from the
bill. When they age out of child foster care, they could just
roll over into an adult foster care license with their current
licenses and the home and services would not be disrupted. Her
young adult is never going to improve and cannot take advantage
of other services like transportation. She will always need the
same level of care or greater as she ages.
MS. EPPERSON said they call themselves foster parents but they
are assisted living providers. They provide 24 hour care and the
only help is respite. The client has some day hab hours, so she
can get in a van and get out of the house. They are paid a
stipend by through the agency they work through. They have a
care coordinator and act as guardians for her. They must abide
by all regulations for an assisted living home designed for a
multipatient facility. Adult foster care would make life for the
client and the home simpler and easier.
VICE CHAIR HUGHES thanked her for her efforts and asked if she
worked with Senator Dunleavy on this a few years ago.
MS. EPPERSON replied that she was one of three women working on
then SB 10. They have been trying to work on this for years.
VICE CHAIR HUGHES said she was glad to see the efforts come to
fruition.
2:49:23 PM
LINDA GIANI, representing self, Wasilla, Alaska, said she has
been working on trying to get this legislation passed since
2011. She first started working with a former governor and then
Senator Dunleavy and some house representatives. It has been up
and down. Governor Dunleavy agreed to continue to pursue this.
She had a son who was one of most disabled children in the state
of Alaska. He passed away two years ago. She is a care
coordinator and works with children on CMS waivers. She has seen
a need for this for a long time and is hoping that it will be
taken care of. As these children turn 18, the important thing is
that they not lose any of their services. They turn 18 and
suddenly they have to live in assisted living where the
expectation is that they will get better. All the in-home
supports are taken away, which is the only service that they
need to have. It is exhausting to take care of these children.
She did it for 21 years all by herself. The foster parents of
these children have to be aware of the children 24/7. The adult
foster care license has been needed for many years. She is
praying that it goes through this time and it includes personal
care services. They lose all that because they turn 18, which
doesn't make sense because there is no other change except age.
She hopes the new license permits families to get the in-home
support services. The waiver services are meaningless unless the
in-home support piece is added. There are many families who have
been in the system for many years, like Lois Epperson. She has
such admiration for them. For 10 years this has been her
project. She worked with the governor for years on this. It is
time.
2:54:22 PM
VICE CHAIR HUGHES thanked her for all she has done for the
precious, disabled Alaskans and her decade of persistence. She
closed public testimony and held SB 98 in committee.
SENATOR BEGICH thanked the members for the robust discussion.
That allows them to know what is going on with bills.
VICE CHAIR HUGHES said it was informative and about some
important matters.
SENATOR REINBOLD said these are important and interesting bills.
This is why there is Health and Social Services, for when people
are truly in need and dependent on people.
2:56:25 PM
There being no further business to come before the committee,
Vice Chair Hughes adjourned the Senate Health and Social
Services Standing Committee meeting at 2:56 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 89 Version A.PDF |
HHSS 5/4/2021 3:00:00 PM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 Transmital Letter.pdf |
SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 Sectional Analysis Version GS 1675 A.pdf |
HHSS 5/13/2021 3:00:00 PM SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 Fiscal Note 1 DHSS.PDF |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 FAQ on Final Rule prepared by Coalition for Community Choice.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 Final Rule 42 CFR 441.301c.pdf |
SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 One Page Summary.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 Settings Information webpage.pdf |
HHSS 4/29/2021 3:00:00 PM SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 All Ways Caring Letter of Support.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 Letter of Support Samash_Redacted.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 98 Version 32 GS 1708 A.PDF |
SHSS 3/18/2021 1:30:00 PM |
SB 98 |
| SB 98 Transmittal Letter.pdf |
SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 98 |
| SB 98 Sectional Analysis Version GS 1708 A.pdf |
SFIN 4/7/2021 9:00:00 AM SFIN 3/31/2022 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 98 |
| SB98 Fiscal Note 1 DHSS Medicaid.PDF |
SHSS 3/18/2021 1:30:00 PM |
SB 98 |
| SB98 Fiscal Note 2 DHSS Senior Svcs.PDF |
SHSS 3/18/2021 1:30:00 PM |
SB 98 |
| SB98 Fiscal Note 3 DHSS Health Care Svcs.PDF |
SHSS 3/18/2021 1:30:00 PM |
SB 98 |
| SB 98 Adult Foster Care for Disabled Graphic.pdf |
SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 98 |