Legislature(2021 - 2022)BUTROVICH 205

03/18/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES

Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.

Download Mp3. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 89 ASSISTED LIVING HOMES: HOUSE RULES TELECONFERENCED
Heard & Held
-- Invited & Public Testimony --
*+ SB 98 ADULT FOSTER CARE FOR DISABLED TELECONFERENCED
Heard & Held
-- Invited & Public Testimony --
+ Bills Previously Heard/Scheduled 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