Legislature(2021 - 2022)BUTROVICH 205
04/26/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB62 | |
| SB242 | |
| SB183 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 62 | TELECONFERENCED | |
| += | SB 242 | TELECONFERENCED | |
| *+ | SB 183 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 26, 2022
1:35 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Shelley Hughes, Vice Chair
Senator Lora Reinbold
Senator Tom Begich
MEMBERS ABSENT
Senator Mia Costello
COMMITTEE CALENDAR
COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 62(JUD) AM
"An Act relating to the Legislative Ethics Act; relating to
solemnization of marriage; and relating to consent to marriage."
- MOVED SCS CSHB 62(HSS) OUT OF COMMITTEE
SENATE BILL NO. 242
"An Act relating to exemptions for the purchase and sale of
certain food products for home consumption under the Alaska Food
Freedom Act."
- HEARD & HELD
SENATE BILL NO. 183
"An Act relating to home and community-based services; and
providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 62
SHORT TITLE: MARRIAGE: WITNESSES/SOLEMNIZATION/CONSENT
SPONSOR(s): REPRESENTATIVE(s) CLAMAN
02/18/21 (H) PREFILE RELEASED 1/15/21
02/18/21 (H) READ THE FIRST TIME - REFERRALS
02/18/21 (H) STA, JUD
02/25/21 (H) STA AT 3:00 PM GRUENBERG 120
02/25/21 (H) -- MEETING CANCELED --
03/04/21 (H) STA AT 3:00 PM GRUENBERG 120
03/04/21 (H) Heard & Held
03/04/21 (H) MINUTE(STA)
03/09/21 (H) STA AT 3:00 PM GRUENBERG 120
03/09/21 (H) Heard & Held
03/09/21 (H) MINUTE(STA)
03/11/21 (H) STA AT 3:00 PM GRUENBERG 120
03/11/21 (H) Moved HB 62 Out of Committee
03/11/21 (H) MINUTE(STA)
03/12/21 (H) STA RPT 4DP 2DNP 1AM
03/12/21 (H) DP: CLAMAN, STORY, TARR, KREISS-TOMKINS
03/12/21 (H) DNP: EASTMAN, VANCE
03/12/21 (H) AM: KAUFMAN
03/19/21 (H) JUD AT 1:30 PM GRUENBERG 120
03/19/21 (H) <Bill Hearing Canceled>
03/24/21 (H) JUD AT 1:30 PM GRUENBERG 120
03/24/21 (H) Heard & Held
03/24/21 (H) MINUTE(JUD)
03/29/21 (H) JUD AT 1:00 PM GRUENBERG 120
03/29/21 (H) <Bill Hearing Canceled>
03/31/21 (H) JUD AT 1:00 PM GRUENBERG 120
03/31/21 (H) Moved CSHB 62(JUD) Out of Committee
03/31/21 (H) MINUTE(JUD)
04/05/21 (H) JUD RPT CS(JUD) NEW TITLE 4DP 3DNP
04/05/21 (H) DP: DRUMMOND, KREISS-TOMKINS, SNYDER,
CLAMAN
04/05/21 (H) DNP: EASTMAN, VANCE, KURKA
03/09/22 (H) SUSTAINED RULING OF CHAIR Y21 N14 E4 A1
03/11/22 (H) TECHNICAL SESSION 3/11 - ON 3/14
CALENDAR
03/16/22 (H) TRANSMITTED TO (S)
03/16/22 (H) VERSION: CSHB 62(JUD) AM
03/18/22 (S) READ THE FIRST TIME - REFERRALS
03/18/22 (S) HSS, JUD
04/05/22 (S) HSS AT 1:30 PM BUTROVICH 205
04/05/22 (S) Heard & Held
04/05/22 (S) MINUTE(HSS)
04/19/22 (S) HSS AT 1:30 PM BUTROVICH 205
04/19/22 (S) Heard & Held
04/19/22 (S) MINUTE(HSS)
04/26/22 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 242
SHORT TITLE: EXEMPTIONS FOR FOOD PRODUCTS
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
04/08/22 (S) READ THE FIRST TIME - REFERRALS
04/08/22 (S) HSS, FIN
04/19/22 (S) HSS AT 1:30 PM BUTROVICH 205
04/19/22 (S) Heard & Held
04/19/22 (S) MINUTE(HSS)
04/26/22 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 183
SHORT TITLE: HOME AND COMMUNITY-BASED SERVICES
SPONSOR(s): GRAY-JACKSON
02/08/22 (S) READ THE FIRST TIME - REFERRALS
02/08/22 (S) HSS, FIN
04/26/22 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
JASMIN MARTIN, Staff
Senator David Wilson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions on SB 242.
CHRISTINA CARPENTER, Director
Division of Environmental Health
Department of Environmental Conservation
Anchorage, Alaska
POSITION STATEMENT: Answered questions on SB 242.
EMMA POKON, Deputy Commissioner
Department of Environmental Conservation
Juneau, Alaska
POSITION STATEMENT: Answered questions on SB 242
DAVID RHODES, Chief Assistant Attorney;
Statewide Section Supervisor
Special Litigation and Consumer Protection
Civil Division
Department of Law
Anchorage, Alaska
POSITION STATEMENT: Answered questions on SB 242
SENATOR ELVI GRAY-JACKSON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of SB 183.
BESSE ODOM, Staff
Senator Elvi Gray-Jackson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the sectional analysis for SB 183.
JOHN LEE, Director
Division of Senior and Disability Services
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Answered questions on SB 183.
KATHERINE BACON, representing self
Palmer, Alaska
POSITION STATEMENT: Testified by invitation on SB 183.
DEBBIE MULHOLLAND, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified by invitation on SB 183.
MARIANA MORANTE, Research and Policy Manager
Service Employees International Union (SEIU) 775
Seattle, Alaska
POSITION STATEMENT: Testified in support of SB 183.
ACTION NARRATIVE
1:35:41 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:35 p.m. Present at the
call to order were Senators Hughes, Reinbold, Begich and Chair
Wilson.
HB 62-MARRIAGE: WITNESSES/SOLEMNIZATION/CONSENT
1:36:39 PM
CHAIR WILSON announced the consideration of CS FOR HOUSE BILL
NO. 62(JUD) am "An Act relating to the Legislative Ethics Act;
relating to solemnization of marriage; and relating to consent
to marriage."
[The committee adopted SCS CSHB 62(HSS) 4/19/22 hearing.]
SENATOR BEGICH asked for confirmation that under the Senate CS
an emancipated minor would retain the right to marry.
CHAIR WILSON said it was stated on the record during the
previous hearing and the memorandum from Legislative Legal
Services was discussed. He noted that nobody from Legal Services
was online to respond to the question today, but he would ask
for a response during hearings in the next committee of
referral.
1:36:53 PM
SENATOR BEGICH said he knows the memorandum effectively says an
emancipated youth is considered an adult for purposes of the
contract of marriage and he appreciates the chair's assurance
and the discussion that's on the record.
SENATOR REINBOLD asked whether the committee would hear the
amendments from Senator Costello.
1:38:18 PM
At ease.
1:40:20 PM
CHAIR WILSON reconvened the meeting. Finding no final questions
for the sponsor, he solicited a motion.
1:40:34 PM
SENATOR HUGHES moved to report the [Senate Committee Substitute]
for HB 62, work order 32-LS0272\I, from committee with
individual recommendations and attached fiscal note(s).
CHAIR WILSON asked if there was objection.
1:40:48 PM
At ease.
1:40:58 PM
CHAIR WILSON reconvened the meeting.
1:41:01 PM
CHAIR WILSON found no objection and SCS CSHB 62(HSS) was
reported from the Senate Health and Social Services Standing
Committee.
1:41:06 PM
At ease.
SB 242-EXEMPTIONS FOR FOOD PRODUCTS
1:44:27 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 242 "An Act relating to
exemptions for the purchase and sale of certain food products
for home consumption under the Alaska Food Freedom Act."
He asked whether the department had any comments before the
committee moved into the amendment process.
1:44:55 PM
CHRISTINA CARPENTER, Director, Division of Environmental Health,
Department of Environmental Conservation, Anchorage, Alaska,
stated that the department has no comments at this time.
1:45:12 PM
CHAIR WILSON moved to adopt Amendment 1, work order 32-
GS2521\A.1.
32-GS2521\A.1
Bullard
4/25/22
AMENDMENT 1
OFFERED IN THE SENATE BY SENATOR WILSON
TO: SB 242
Page 2, lines 9 - 10:
Delete "non-potentially hazardous"
Insert "nonhazardous"
Page 2, line 26:
Delete "non-potentially hazardous"
Insert "nonhazardous"
Page 2, lines 27 - 29:
Delete "A retail space selling a homemade food
product under this section shall inform the end
consumer that the product has not been inspected and
shall display a sign indicating that the product has
not been inspected."
Page 3, line 9:
Delete "non-potentially hazardous"
Insert "nonhazardous"
Page 3, lines 10 - 12:
Delete "shall be clearly and prominently labeled
with the following language: "This food was made in a
home kitchen, is not regulated or inspected and may
contain allergens." The non-potentially hazardous food
for sale at the retail location or grocery store"
Page 3, line 17:
Delete "non-potentially hazardous"
Insert "nonhazardous"
Page 3, line 20:
Delete ";"
Insert "."
Page 3, lines 21 - 24:
Delete all material and insert:
"(g) A producer or other seller of eggs or a
nonhazardous food product under AS 17.20.331 -
17.20.339 shall include a clearly visible warning
stating "This food is not regulated or inspected,
and may contain allergens"
(1) on a label attached to the packaging of
the eggs or nonhazardous food product; or
(2) if the eggs or nonhazardous food product
do not have packaging or cannot be easily labeled,
on signage in the area where the eggs or
nonhazardous food product are sold.
(h) A producer of a potentially hazardous food
product, except for eggs, under AS 17.20.331 -
17.20.339 shall include a clearly visible warning
stating "This food is not regulated or inspected and
may contain allergens. It is not for resale"
(1) on a label attached to the packaging of
the potentially hazardous food product; or
(2) if the potentially hazardous food product
does not have packaging or cannot be easily labeled,
on signage in the area where the hazardous food
product is sold."
Page 6, line 29:
Delete "non-potentially hazardous"
Insert "nonhazardous"
Page 7, line 1:
Delete "non-potentially hazardous"
Insert "nonhazardous"
1:45:15 PM
SENATOR HUGHES objected for purposes of discussion.
1:45:19 PM
CHAIR WILSON provided the following explanation of Amendment 1:
This amendment requires labeling on food sold from a
producer to the end customer. That brings labeling and
food requirements for food sold through a third party
in line with food directly sold to the producer to
customer. It requires that hazardous food is sold by
the producer directly to the consumer to either be
clearly labeled, "This food is not regulated or
inspected and may contain allergens, and it's not for
resale, or the food does not have packaging label
that can be affixed to it like farmer market that they
have clear signage on the food letting folks know that
this food is not regulated or inspected or may contain
allergens and is not for resale type of purposes.
[The amendment] also requires nonhazardous foods to be
sold by the producer and a third party to be either
clearly labeled with the same thing "This food is
not regulated or inspected and may contain allergens,
and it's not for resale," or this food does not have
the packaging that can be easily affixed to and there
must be clear signage, again, where the food is sold.
And it also replaces the term "non-potentially
hazardous" with the term "nonhazardous."
1:46:33 PM
SENATOR REINBOLD asked if he knew what it would cost for
somebody to comply with the labeling and signage requirements.
CHAIR WILSON said he didn't know, but producers he spoke with
said nobody had ever asked whether the product was made in a
safe and sanitary kitchen.
1:47:48 PM
SENATOR BEGICH he has done home labeling and it doesn't cost
very much and isn't difficult.
SENATOR REINBOLD asked why the term "non-potentially hazardous"
is replaced with the term "nonhazardous." She said it seems like
a very high standard and she was concerned about exposing people
to liability.
1:49:03 PM
JASMIN MARTIN, Staff, Senator David Wilson, Alaska State
Legislature, Juneau, Alaska, explained that Legislative Legal
Services decided to correct that term when it made drafting
changes to comply with legislative drafting standards.
SENATOR REINBOLD commented that she didn't know of any product
that was required to say on the label that it was nonhazardous.
MS. MARTIN said the amendment does not require that term to be
on the label; it's a term that is used throughout the
legislation and is in the definitions section.
SENATOR HUGHES recalled that an initial presentation talked
about classifying foods and that one category was nonhazardous.
1:50:49 PM
MS. MARTIN said that's correct and the department could speak to
that. She pointed out that the amendment only changes the
terminology; it does not change the definition of hazardous,
non-potentially hazardous, or nonhazardous.
1:51:09 PM
CHRISTINA CARPENTER, Director, Division of Environmental Health,
Department of Environmental Conservation, stated that as
originally drafted, the bill defined potentially hazardous foods
as those that require time and temperature control to prevent
the risk of foodborne illness. Non-potentially hazardous foods
don't need that time and temperature control. The original bill
also had different labeling requirements for potentially
hazardous foods and non-potentially hazardous foods. She agreed
with Ms. Martin that Amendment 1 does not require the food to be
labeled to identify it as potentially hazardous, non-potentially
hazardous, or [nonhazardous].
SENATOR HUGHES said she didn't want to suggest anything on the
fly, but she was thinking about other points where consumers
should be informed.
SENATOR REINBOLD asked if these foods needed to have signage
about their hazard level but it didn't need to be on the label.
1:54:46 PM
CHAIR WILSON asked if she was asking about the products that
would need a label versus those that would not.
SENATOR REINBOLD said that's part of it but she was trying to
understand the difference between the requirement for signage
versus labels.
CHAIR WILSON explained that a jar of jam would have to have a
label affixed, but a head of lettuce would have signage because
a label could not readily be affixed.
1:55:19 PM
SENATOR BEGICH said the only things that have to be signed or
labeled are those identified in the phrases: "This food was made
in a home kitchen, is not regulated or inspected, and may
contain allergens."; and "This food is not regulated or
inspected and may contain allergens." The language on page 2,
line 20 clarifies that the food is not for resale. The language
on page 2, lines 11-12 and lines 19-20 is part of that. He asked
Ms. Martin if she agreed.
MS. MARTIN said that is correct.
CHAIR WILSON asked if there was further debate on Amendment 1.
1:56:35 PM
EMMA POKON, Deputy Commissioner, Department of Environmental
Conservation (DEC), Juneau, Alaska, stated that DEC was
comfortable with the amendment.
1:56:50 PM
SENATOR HUGHES removed her objection.
1:556 PM
CHAIR WILSON found no further objection, and Amendment 1 was
adopted.
1:57:00 PM
SENATOR HUGHES moved to adopt Amendment 2, work order 32-GS2521\A.2.
32-GS2521\A.2
Bullard
4/25/22
AMENDMENT 2
OFFERED IN THE SENATE BY SENATOR HUGHES
Page 7, line 12, following "property;":
Insert "and"
Page 7, lines 14 - 16:
Delete "and
(C) does not exceed two hundred fifty thousand
dollars in gross revenue annually from the food
products;"
1:57:02 PM
CHAIR WILSON objected for purposes of discussion.
1:57:05 PM
SENATOR HUGHES explained that Amendment 2 removes the annual
$250,000 sales cap. Feedback from the industry indicates that
this would be helpful for startup businesses. This will likely
stimulate more interest, which may help with food security.
1:58:04 PM
SENATOR BEGICH expressed concern that removing the cap would be
an open invitation for large producers to potentially avoid
inspection. He asked for the departments view.
MS POKON said the amendment is responsive to the concerns that
stakeholders expressed when the bill was first introduced. DEC
would retain the ability to address any concerns about foodborne
illnesses if they should arise.
SENATOR BEGICH pointed out that any follow up on illness would
be after the fact.
2:00:09 PM
MS. POKON confirmed that was correct.
SENATOR BEGICH said perhaps a higher cap is appropriate to
recognize startup costs, but he was not comfortable with the
department abrogating its responsibility for environmental
safety to ensure there are no foodborne illnesses. He said he
could support a higher cap but he could not support no cap.
2:01:21 PM
CHAIR WILSON said paragraph (14) still has the two items in
subparagraphs (A) and (B) that talk about what it means to be a
producer. The individual may not produce more than two hundred
fifty thousand individual food products each year and they must
grow, harvest, prepare, process, or make and package the food
product on land they own or lease. He opined that (A) and (B)
would eliminate commercial entities.
SENATOR HUGHES asked, should the amendment pass, would an
illness need to occur or could the department intervene if an
end consumer reported a problem.
2:02:42 PM
MS. POKON directed attention to the exceptions listed on page 4.
She read that nothing prevents the department from conducting an
inspection based on a report of foodborne illness, unsafe
sanitary practices, or misbranded or adulterated food. That
authorizes the department to respond to such complaints.
SENATOR HUGHES expressed satisfaction with the level of
protection to the end consumer.
SENATOR BEGICH said he was uncomfortable but he wouldn't object.
2:04:26 PM
CHAIR WILSON removed his objection. Finding no further
objection, Amendment 2 was adopted.
2:05:02 PM
At ease.
2:05:31 PM
CHAIR WILSON reconvened the meeting and noted that David Rhodes
was available to respond to questions that were asked earlier.
He asked Senator Hughes to restate her question.
2:05:53 PM
SENATOR HUGHES asked whether the signage and labeling called for
in Amendment 1 would relieve a producer of liability should an
end consumer get sick from that producer's product.
2:06:35 PM
DAVID RHODES, Chief Assistant Attorney General; Statewide
Section Supervisor, Special Litigation and Consumer Protection,
Civil Division Department of Law, Anchorage, Alaska, stated that
the bill does not create or eliminate any new liability for
manufacturers.
2:07:07 PM
SENATOR HUGHES noted that no new liability assumes there already
is some liability. She asked if there were any protections that
could be put into the law so that producers or manufacturers
that are contributing to food security would be less subject to
debilitating lawsuits.
MR. RHODES said he'd defer the discussion to the agency, but he
believes there are options for the legislature to consider that
would reduce liability.
SENATOR HUGHES asked whether the department could suggest ways
to reduce liability for producers.
2:08:30 PM
CHAIR WILSON asked Deputy Director Pokon to work with the
Department of Law on suggested options for the committee to
consider. The information could be forwarded to his office for
distribution to the members.
2:08:44 PM
MS. POKON stated that if it was the will of policymakers, DEC
would be happy to have those discussions. She agreed with Mr.
Rhodes that the bill, as written, does not affect the current
landscape regarding liability for producers.
2:09:13 PM
CHAIR WILSON stated that he would hold SB 242 in committee for
future consideration.
2:09:41 PM
At ease
SB 183-HOME AND COMMUNITY-BASED SERVICES
2:13:02 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 183 "An Act relating to home
and community-based services; and providing for an effective
date."
2:13:33 PM
SENATOR ELVI GRAY-JACKSON, Alaska State Legislature, Juneau,
Alaska, sponsor of SB 183, introduced the bill by reading
sponsor statement:
Alaska has recently seen an increased demand for home-
care services from our senior population and those
with disabilities due to both growth in our senior
population and increasing waiting periods to access
home and community-based services. Currently, we are
unable to meet these demands. We have seen many
individuals who qualify for Home and Community-Based
Services (HCBS) waivers and Community First Choice
Medicaid State Plan (K) have service levels cut, get
stuck on waiting lists for long periods of time, or
unable to hire caregivers of their choice. There is a
high need for caregivers yet hourly wages for
caregivers has declined over the past decade.
This harms Alaskans everywhere. Without access to
home-care services, many Alaskans either go without
the care they need, rely exclusively on unpaid and
untrained friends and family members, or are forced to
move thousands of miles away from their community and
support systems to receive institutional care.
SB 183 takes steps to ensure that Alaskans who need
in-home care receive it, so they may live with dignity
and independence at home, while providing more
stability to caregivers. This bill will raise the
threshold for reduction of benefits, ensure benefit
recipients are notified of eligibility assessment
results and their options for appeal, and allow for
re-assessment of eligibility for those whose levels of
service have been reduced over the past two years. It
will make it easier for eligible caregivers to become
Personal Care Assistants under HCBS waivers and the
Community First Choice Medical State Plan (K).
Passing SB 183 helps Alaska meet the in-home care
needs of seniors and people with disabilities. It
ensures more Alaskans can stay in their homes and
communities and maintain their dignity and
independence. It also provides improved stability for
the direct-care workforce. I hope you'll join me in
supporting SB 183.
2:16:00 PM
BESSE ODOM, Staff, Senator Elvi Gray-Jackson, Alaska State
Legislature, Juneau, Alaska, presented the sectional analysis
for SB 183 reading the following:
Sec. 1: Amends AS 47.07.045(a) Home and community-
based services for provisions in the section to apply
also to Community First Choice and Medicaid personal
care services programs.
Sec. 2: Amends AS 47.07.045(a) Home and community-
based services by:
? Introducing a process in statute for reducing hours
or payment for home and community-based services
provided under 1915(k) state plan option and Medicaid
personal care services that mirrors the process for
terminating services.
? Adding "and live independently" as a condition for
terminating services.
Requiring the department to continue following
notice requirements provided in later sections.
Sec. 3: Amends AS 47.07.045(d) Home and community-
based services by:
? Moving definitions for "independent qualified health
care professional" and "independent qualified waiver"
to this section. It does not create any new
definitions.
? "Independent qualified health care professional" for
an intellectual or developmental disability waiver is
defined as a qualified intellectual disability
professional under 42 C.F.R. 483.430.
? For other allowable waivers, "Independent health
care professional" is defined as a person who can
provide personal care services under the 1915(k) state
plan or a registered nurse with specific
qualifications relevant to the waivers.
Sec. 4: Adds a new subsection to AS 47.07.045 Home and
community-based services that:
? Establishes that once the department receives the
results of an assessment they have 10 days to notify,
in writing, the recipients or individuals with legal
authority to act on the recipient's behalf of the
assessment results.
? Establishes that after the department decides if
there will be a change in levels of services or
payments for services, they have 10 days after the
decision is made to notify the recipient or
individuals with legal authority to act on the
recipient's behalf of the decision. This notice must
be done in writing and 30 days before the new
determination goes into effect. The department must
also inform them they have a right to appeal the
decision.
? Allows legally responsible persons to provide
personal care services to an individual eligible for
home and community-based services waivers and
Community First Choice.
Sec. 5: Adds a new section that creates a path for
hours to be restored through the proposed reassessment
process for recipients of care whose payment for
services were reduced between January 1, 2019 and
January 1, 2022.
Sec. 6: Adds a new section to instruct the Department
of Health and Social Services to amend and submit a
state plan for medical services to the Centers for
Medicare and Medicaid Services (CMS).
Sec. 7: Makes section 5 retroactive to January 1,
2019.
Sec. 8: Establishes the act will take effect only upon
federal approval of the state plan for medical
assistance, and that if approved, the Commissioner of
the Department of Health and Social Services must
notify the revisor of statute not later than 30 days
after receiving notice.
Sec. 9-10: Create two effective dates:
? For sections 1 4, effective date will be the day
after the revisor of statutes receives notification
from the Commissioner of Health and Social Services of
federal approval of state plan amendments.
? Sections 5 and 7 take effect immediately upon
passage.
2:20:42 PM
CHAIR WILSON listed the individuals available to answer
questions.
2:21:00 PM
SENATOR BEGICH mentioned a memorandum he received that discusses
the incentive mechanism the [Department of Health and Social
Services (DHSS)] uses and the concern it has with the
legislation that there is an expectation that individuals gain
skills to take better care of themselves. He said his concern is
that some people are never going to gain new skills because they
are permanently disabled. He called the requirement to show
continued progress when it's not possible a loophole in the law.
He asked whether the bill rectified that conundrum.
2:23:19 PM
SENATOR GRAY-JACKSON answered that she believes SB 183 does
rectify that situation because it allows a repeal process. She
suggested that the department could give a more in-depth
response.
2:23:41 PM
JOHN LEE, Director, Division of Senior and Disability Services,
Department of Health and Social Services (DHSS), Anchorage,
Alaska, said he believes the discussion is about a Center for
Medicare and Medicaid Services (CMS) concept called fading that
applies to individuals who have the capacity to obtain new
skills or competencies to perform certain tasks. He acknowledged
that this isn't available for many individuals that the
department supports because their conditions will not get
better. However, for supportive employment there is a CMS
requirement that as skills and competencies are developed, the
supportive process in place will fade.
SENATOR BEGICH referenced page 4 of the memorandum from the
department that indicates that SB 183 would negatively affect
the federal policy called fading.
2:25:42 PM
MR. LEE answered yes; the department would need federal approval
to remove the requirement for fading to be part of the
department's program.
SENATOR BEGICH noted that the memorandum said, "The department
is eager to work with the sponsor to better understand the goal
of the bill." He asked Mr. Lee if he'd met with the sponsor to
discuss the concern.
MR. LEE answered yes and he appreciated that Senator Gray-
Jackson participated in the dialog and was open to potential
changes. The department also met with the sponsor of the House
companion bill who agreed to some positive changes. The
department looks forward to continuing conversations with both
sponsors to improve the legislation and reduce the concerns
articulated in the fiscal note.
SENATOR HUGHES asked if CMS would have to issue a formal waiver
to eliminate the requirement for a person to be developing their
skills to progress towards employment. She also asked whether
individuals who lose eligibility because their skills and
competencies aren't improving are eligible for help under a
different type of funding.
2:28:18 PM
MR. LEE said the bill affects the department's Personal Care
Services Program and the Home and Community Based waiver
programs. To implement the changes the bill calls for, these
three programs would have to make changes to the regulations and
potentially get approval from the Center for Medicare and
Medicaid Services. The department is currently receiving the
American Rescue Plan enhanced federal match for HCBS and because
some of the provisions in the proposed statute would be more
restrictive, it may be necessary to delay implementing the
changes until after March 31, 2024. To the question about
funding, he said the lack of progress toward employment doesn't
typically trigger the loss of that aspect of the person's
waiver. He asked if she could give specific examples of that
happening so he could give a more precise response.
2:30:04 PM
SENATOR HUGHES suggested he follow up with the Governor's
Council on Disabilities and Special Education because she
recalled testimony from people with severe disabilities who have
lost services because they were not progressing. She also asked
whether the regulation changes he mentioned earlier referred to
state or federal regulations.
MR. LEE answered that the waiver and state plan amendments would
require approval from CMS, but he saw no need to change either
federal statutes or federal regulations.
SENATOR HUGHES shared her personal experience when her father
was in a recovery center receiving therapy after hip surgery.
For Medicare to pay, he had to show he was making progress. When
he stopped making progress, he lost the therapy and declined
rapidly. She offered her belief that the requirement to continue
to show progress to stay on a program needs to be revisited with
CMS.
2:33:48 PM
SENATOR BEGICH asked if the two retroactive clauses were due to
COVID-19.
SENATOR GRAY-JACKSON deferred to Ms. Odom.
MS. ODOM answered yes.
SENATOR BEGICH elaborated that it returns to the standard prior
to the COVID-19 pandemic.
SENATOR GRAY-JACKSON agreed.
SENATOR REINBOLD asked for further clarification because January
1, 2019 was before the pandemic.
SENATOR BEGICH said it's set for the beginning of the calendar
year. He suggested the department comment.
CHAIR WILSON noted that the department declined to comment on a
policy call.
2:36:20 PM
CHAIR WILSON turned to invited testimony.
2:36:37 PM
KATHERINE BACON, representing self, Palmer, Alaska, stated that
she has been a special needs caregiver for 25 years, starting
with her medically fragile granddaughter. She is now the primary
caregiver to her late husband's grandson Michael who has a
traumatic brain injury. Countless caregivers have come and gone
because the pay isn't very good. She is fortunate to be paid to
care for Michael, but the process to get qualified to retain a
caregiver let alone to qualify to be a caregiver is too
difficult for a lot of families. Many of the paid and unpaid
people doing this work are struggling and reaching the breaking
point.
MS. BACON described SB 183 as the first small step towards the
urgently needed repair of a broken system by reducing barriers
to access to care and restoring client hours. These two changes
will help keep vulnerable Alaskans like Michael safer.
2:41:09 PM
DEBBIE MULHOLLAND, representing self, Anchorage, Alaska, stated
that she has been a caregiver for nearly 10 years. SB 183 is
important to her clients, most of whom are seniors. They are in
need of care and often can't get it. She shared the following
story from her prepared testimony:
I have one client who is bed ridden and his daughter
has been taking care of him. I only see him five hours
per day, four days per week. I can see that it is very
hard on her mental and physical health because of
physical abuse due to her father's dementia. She
doesn't get any breaks or help from other caregivers
besides me. It worries me that caregivers are
experiencing these kinds of hardships on a daily basis
because there is simply not enough funding for
caregiving.
MS. MULHOLLAND stressed that families are struggling because
they can't find caregivers and caregivers are struggling because
their clients only qualify for two hours of care per day a few
times a week so they leave to find more stable employment. This
often leaves the families to fill the gap. [Audio was
indiscernible.]
CHAIR WILSON advised that the committee could not hear the
testimony.
2:43:33 PM
MS. MULHOLLAND stated that the cuts to the caregiver programs
have gone too far. Some seniors are no longer able to get help
for their most basic needs. She urged the committee to pass SB
183.
2:45:29 PM
CHAIR WILSON opened public on SB 183.
SENATOR HUGHES thanked the caregivers who gave testimony for the
work they do.
CHAIR WILSON asked Mariana Morante if she wanted to provide
testimony or comment on the bill and she declined.
2:46:55 PM
CHAIR WILSON closed public testimony on SB 183.
SENATOR GRAY-JACKSON suggested Ms. Morante address the concerns
DHSS articulated.
2:47:36 PM
MARIANA MORANTE, Research & Policy Manager, Service Employees
International Union (SEIU) 775, Seattle, Washington, stated that
SB 183 seeks to prevent caregiver hours from being cut for
clients who need those services. The bill mirrors the existing
process for terminating services. That involves an independent
health provider conducting an assessment to verify that the
client would be able to function in a home and live
independently. The bill ensures that what the caregivers
provided in testimony today does not happen, so everyone
receives the level of care needed to function in a home and live
independently.
CHAIR WILSON offered his view on indeterminate fiscal notes, and
asked Mr. Lee to discuss how the bill would work, how it would
be implemented, and what it would cost the state.
2:49:32 PM
MR. LEE stated that SB 183 would fundamentally change nearly
every aspect of processing and managing the department's
portfolio of businesses. It would also require extensive
consultation with CMS on how to implement the bill. He justified
the indeterminate fiscal note saying that the number of
processes that would need to be changed and the number of
additional staff that would be needed and managed would vary
depending on whether the Senate or House version of the bill
passed. He opined that it would take weeks of concerted effort
with the entire leadership team to provide a guestimate of the
actual costs to hire additional staff, to contract for third-
party reviews, and to determine what assessments would be
required and when. A final determination would likely be after
public comment and consultation with CSM.
2:51:41 PM
CHAIR WILSON said he appreciates that but legislators rely on
good faith estimates from the departments to make the best
decisions possible.
CHAIR WILSON asked if the bill could be implemented given the
changes the federal government has made to Medicaid, including
the moratorium on enrollment.
MR. LEE opined that certain aspects of the bill would be
problematic and need to be delayed given that the department is
taking advantage of the American Rescue American Rescue Plan
enhanced federal match for certain programs. There may also be
required assessments that aren't currently required and those
would need to be delayed until after March 31, 2024.
SENATOR HUGHES pointed out that the department would also need
to get any waiver applications approved by CMS. She asked if he
agreed that it's more involved than simply passing the bill.
2:53:57 PM
MR. LEE said that's correct.
SENATOR BEGICH commented that he was pleased that the Chair was
on the Finance Committee because the questions about the fiscal
note will be significantly more difficult to answer in that
venue. He also observed that the administration appears to have
no interest in this legislation moving forward. He asked if he
was hearing that correctly.
MR. LEE responded that the department has worked hard and has
had multiple meetings with the sponsors of both the Senate and
House bills. He apologized for giving the impression of no
interest because that was not the intent. There is a lot of
interest in making a better bill, he said.
SENATOR REINBOLD commented that she doesn't have a lot of
compassion for a department that can't come up with a fiscal
note when it's now two departments with addition staff. She said
this is an important issue for the people who need care, the
families, and the caregivers. She added that her problem with
public assistance relates to the expansion of Medicaid. It's
made the budget too large.
2:57:52 PM
SENATOR GRAY-JACKSON stated that this bill is very important and
she appreciates the support. She also agreed with the comment
about the two departments and the indeterminate fiscal note, and
expressed appreciation for Senator Begich's comments.
CHAIR WILSON asked the sponsor if she had any closing comments.
SENATOR GRAY-JACKSON thanked the committee for considering the
bill
2:59:27 PM
CHAIR WILSON held SB 183 in committee.
3:00:14 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 3:00 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 183, Version A – Supporting Document (Guardianship Overview).pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 183, Version A – Supporting Document (One Pager).pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 183, Version A - Sponsor Statement.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 183, Version A – Supporting Document (Personal Care Services).pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 183, version A.PDF |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| Additional Letters of Support.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| GCDSE Letter of Support 3.14.22.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 183, Version A - Sectional Analysis.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 183 FN DOH MS 4.22.22.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 183 FN DOH SDSA 4.22.22.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 242 Ammendments 4.26.22.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 242 |
| SB 242 Letter- Delta 4.20.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 242 |
| SB 242 A1 Memo Wilson 4.25.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 242 |