02/13/2025 03:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation(s): Expanding Eligibility for Alaska's Infant Learning Program | |
| SB76 | |
| SB60 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 76 | TELECONFERENCED | |
| += | SB 60 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 13, 2025
3:30 p.m.
MEMBERS PRESENT
Senator Forrest Dunbar, Chair
Senator Cathy Giessel, Vice Chair
Senator Matt Claman
Senator Löki Tobin
Senator Shelley Hughes
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
PRESENTATION(S): EXPANDING ELIGIBILITY FOR ALASKA'S INFANT
LEARNING PROGRAM
- HEARD
SENATE BILL NO. 76
"An Act relating to complex care residential homes; and
providing for an effective date."
- HEARD & HELD
SENATE BILL NO. 60
"An Act establishing May 12 as Myalgic Encephalomyelitis/Chronic
Fatigue Syndrome Day of Recognition."
- MOVED SB 60 OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: SB 76
SHORT TITLE: COMPLEX CARE RESIDENTIAL HOMES
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
01/27/25 (S) READ THE FIRST TIME - REFERRALS
01/27/25 (S) HSS, FIN
02/06/25 (S) HSS AT 3:30 PM BUTROVICH 205
02/06/25 (S) Heard & Held
02/06/25 (S) MINUTE(HSS)
02/13/25 (S) HSS AT 3:30 PM BUTROVICH 205
BILL: SB 60
SHORT TITLE: ESTABLISH ME/CHRONIC FATIGUE SYNDROME DAY
SPONSOR(s): TOBIN
01/24/25 (S) READ THE FIRST TIME - REFERRALS
01/24/25 (S) HSS
02/11/25 (S) HSS AT 3:30 PM BUTROVICH 205
02/11/25 (S) Heard & Held
02/11/25 (S) MINUTE(HSS)
02/13/25 (S) HSS AT 3:30 PM BUTROVICH 205
WITNESS REGISTER
SABRINA RICHMOND, Chair
Interagency Coordinating Council (ICC)
Juneau, Alaska
POSITION STATEMENT: Introduced the presentation Expanding
Eligibility for Alaska's Infant Learning Program.
RICH SAVILLE, Program Coordinator
Governor's Council on Disabilities and Special Education
Anchorage, Alaska
POSITION STATEMENT: Stated the priorities of the Governor's
Council on Disabilities and Special Education.
AMY SIMPSON, Executive Director
Programs for Infants and Children
Anchorage, Alaska
POSITION STATEMENT: Offered the presentation Expanding
Eligibility for Alaska's Infant Learning Program.
HEIDI HAAS, Executive Director
Alaska Center for Children and Adults (AACA)
Fairbanks, Alaska
POSITION STATEMENT: Answered questions on Expanding Eligibility
for Alaska's Infant Learning Program.
KIM CHAMPNEY, Executive Director
Alaska Association on Developmental Disabilities
Juneau, Alaska
POSITION STATEMENT: Testified in support of SB 76.
DAVID WALLACE, Chief Executive Officer
Matsu Regional Medical Center
Palmer, Alaska
POSITION STATEMENT: Testified in support of SB 76.
JARED KOSIN, President
Alaska Hospital and Healthcare Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 76.
PHILLIP TAFS, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 76.
LUCY BAUER, Representative
Alaska Assisted Living Home Association
Anchorage, Alaska
POSITION STATEMENT: Testified in support of SB 76.
JAMIE ELKHILL, Vice President
Youth and Transitional Age Youth (TAY) Services
Volunteers of America (VOA) Alaska
Eagle River, Alaska
POSITION STATEMENT: Testified in support of SB 76.
MICHELLE OVERSTREET, Chief Executive Officer
My House
Wasilla, Alaska
POSITION STATEMENT: Testified in support of SB 76.
EMILY RICCI, Deputy Commissioner
Department of Health (DOH)
Juneau, Alaska
POSITION STATEMENT: Answered questions on SB 60.
ACTION NARRATIVE
3:30:31 PM
CHAIR DUNBAR called the Senate Health and Social Services
Standing Committee meeting to order at 3:30 p.m. Present at the
call to order were Senators Hughes, Claman, Giessel, Tobin, and
Chair Dunbar.
^PRESENTATION(S): EXPANDING ELIGIBILITY FOR ALASKA'S INFANT
LEARNING PROGRAM
PRESENTATION(S):
EXPANDING ELIGIBILITY FOR ALASKA'S INFANT LEARNING PROGRAM
3:31:21 PM
CHAIR DUNBAR announced the presentation Expanding Eligibility
for Alaska's Infant Learning Program
3:32:10 PM
SABRINA RICHMOND, Chair, Interagency Coordinating Council (ICC),
Juneau, Alaska, introduced the presentation and stated that she
is also the Vice-Chair of the Governor's Council on Disabilities
and Special Education. She thanked the committee for inviting
the organization to share a presentation on expanding the infant
learning program.
3:33:12 PM
RICH SAVILLE, Program Coordinator, Governor's Council on
Disabilities and Special Education, Anchorage, Alaska, moved to
slide 2 and provided a brief overview of the organization's
priorities for this year. He stated that the Governor's Council
on Disabilities and Special Education is focused on funding and
expanding eligibility for the Infant Learning Program, securing
funding for the Special Education Services Agency, and
addressing public and community transit concerns. He mentioned
legislative efforts related to adult changing tables and a bill
to improve education for deaf and hard-of-hearing children. He
added that additional funding requests include establishing a
State Access and Functional Needs Coordinator within the State
Emergency Operations Center and increasing funding for the Deaf
Navigator Program at Hope Community Resources.
[Original punctuation provided.]
Legislative Priorities:
1. Infant Learning Program funding and expansion of
eligibility 2. Special Education Services Agency
(SESA) funding
3. Public and Community Transit
4. Adult Changing Tables
5. Deaf and Hard of Hearing Children's Bill of Rights
Funding requests:
1. State Access and Functional Needs Coordinator
2. Deaf Navigator Program Funding
3:34:18 PM
AMY SIMPSON, Executive Director, Programs for Infants and
Children, Anchorage, Alaska, offered the presentation Expanding
Eligibility for Alaska's Infant Learning Program. She explained
that Programs for Infants and Children (PIC) operates the Infant
Learning Program in Anchorage, serving Anchorage, Girdwood,
Whittier, and six surrounding communities in the Lake Iliamna
area. She thanked the group for the opportunity to speak and
shared her enthusiasm for the program, noting her 30 years of
experience as a speech-language pathologist and 21 years as
executive director at PIC. She also chairs the Interagency
Coordinating Council (ICC) finance subcommittee for the Infant
Learning Program. She emphasized the importance of supporting
infants and toddlers during the critical birth-to-three
developmental window, citing research showing that young
children can form up to a million neural connections per second
during this period.
3:36:19 PM
MS. SIMPSON explained that the Individuals with Disabilities
Education Act (IDEA) is the federal law governing education for
individuals with disabilities. While most people are familiar
with Part B, which applies to school-aged children receiving
special education, Part C focuses specifically on infants and
toddlers from birth to age three who experience developmental
delays or disabilities. She emphasized that Part C prioritizes
parent involvement, with the goal of equipping parents to
support their child's development through coaching and
engagement in everyday routines.
3:37:17 PM
MS. SIMPSON noted that Alaska's Part C programthe Infant
Learning Programis jointly funded by state and federal sources
and administered by the Department of Health and the Division of
Senior and Disabilities Services. She explained that services
are delivered in natural environments such as homes and
community settings, consistent with the law's definition of
places where typically developing infants and toddlers spend
their time. She emphasized that embedding learning in daily
routines like meals, bath time, and playtime helps parents
reinforce developmental skills consistently throughout the day.
3:39:27 PM
MS. SIMPSON stated that Part C addresses all areas of
development and uses a multidisciplinary and transdisciplinary
approach. She listed the developmental areas supported under
Part C: gross and fine motor skills, cognitive or problem-
solving abilities, social-emotional development, and self-help
skills such as feeding, dressing, and toileting. As a speech-
language pathologist, she highlighted communicationboth
receptive and expressive languageas her area of focus and
personal favorite.
3:41:28 PM
MS. SIMPSON moved to slide 5, The Work That Led Us Here. She
stated that in 2022, the Governor's Council in coordination with
the Interagency Coordinating Council (ICC) appointed a finance
subcommittee, which she chairs, to review the Infant Learning
Program (ILP) system in Alaska and nationally. The subcommittee
examined how other states determine eligibility and fund their
ILP services, since each state has discretion in setting its
criteria. With support from the Alaska Mental Health Trust
Authority, the subcommittee developed a set of recommendations.
MS. A noted that a link to the full list of recommendations will
be available at the end of the presentation, and paper copies
can also be provided upon request.
3:42:38 PM
MS. SIMPSON moved to slide 6, Key Recommendations:
[Original punctuation provided.]
Key Recommendations
Align Part C criteria with Part B (25% delay in one
domain of development or 20% in two) and update the
list of qualifying conditions accordingly.
Increase funding for Alaska ILP to pay for an expected
77 percent increase in children qualifying for ILP
services.
Make supporting changes to the Medicaid statute:
• add new ILP provider type and reimburse for all ILP
services
• allow the Individual Family Service Plan (IFSP) as
an authorizing document for Medicaid coverage
MS. SIMPSON stated that the report contains several
recommendations, with the top priority being the expansion of
Alaska's Part C eligibility. The subcommittee's review found
that Alaska has the most restrictive eligibility criteria in the
nationrequiring a 50 percent delay in one developmental area,
equivalent to a two-year-old functioning at the level of a one-
year-old. She explained that this level of delay, determined
through standardized testing, is so severe that it barely
qualifies as early intervention. The recommendation is to align
Alaska's Part C eligibility with Part B, which requires a 25
percent delay in one area or a 20 percent delay in two or more
areas.
3:43:47 PM
MS. SIMPSON added that the report also recommends expanding the
list of diagnosed conditions that grant automatic eligibility.
While the current list includes conditions such as cerebral
palsy, Down syndrome, and autism, it omits others like
prematurity and unilateral hearing lossconditions associated
with long-term educational challenges. Expanding eligibility is
projected to increase the number of eligible children by 77
percent, based on comparisons with other states that use similar
criteria. This expansion would require a proportional funding
increase of approximately $5.72 million, bringing the total
Infant Learning Program (ILP) budget to just over $13 million.
3:46:00 PM
MS. SIMPSON said another key recommendation focuses on the
financing of Part C services through Medicaid. She explained the
need to establish a specific provider type within Medicaid for
ILP grantees, allowing programs to be reimbursed for all Part C
services as authorized by the Individualized Family Service Plan
(IFSP). This would align with how services are deliveredhome
and community-based rather than clinic-basedand allow for more
comprehensive billing and service tracking. Creating this
provider type would improve the ability to monitor service
delivery and identify gaps in access and equity across the
state. She noted that this change would require a revision to
Medicaid statute.
3:48:08 PM
MS. SIMPSON said currently, 36 states bill Medicaid in this
manner for services such as audiology, assistive technology,
nutrition, psychological services, sign language, social work,
and vision services. At present, Alaska's ILP can only bill
Medicaid and private insurance for occupational, physical, and
speech therapybilled under outpatient clinic codeswhile all
other services are funded solely through state general funds. By
expanding Medicaid billing to include all Part C services,
Alaska could leverage a 50/50 state-federal funding split.
3:49:13 PM
MS. SIMPSON concluded by referencing a cost study conducted in
2009, which included home and community-based services and
outlined the costs of each ILP service. She expressed hope that
this study could be updated for [2025], despite the time and
expense involved, as doing so would enable billing for a broader
range of services and reduce the financial burden on the state.
3:50:22 PM
MS. SIMPSON moved to slide 7, Why Expand Eligibility:
[Original punctuation provided.]
Why Expand Eligibility?
Alaska has the most restrictive eligibility criteria
for early intervention services in the nation.
Only two other states require a 50 percent
developmental delay. Most states use 33 percent or 25
percent.
Alaska Part B (K-12 special education) uses a 25
percent threshold.
The difference results in delayed onset of services
for children with 25-49 percent delay.
Often-cited studies by James Heckman have shown high
return on investment for early intervention: For every
$1 invested, up to $17 saved.
46 percent of children that receive early intervention
don't require special education by the time they get
to
Kindergarten, which represents annual savings up to
$34.9M.
Early intervention improves long-term outcomes for
children, families, and the state.
MS. SIMPSON emphasized the importance of expanding Part C
eligibility to close the 25 percent gap between current Part C
and Part B criteria. She stated that earlier identification
leads to better outcomes for children. She referenced the
Heckman Equation, which shows a $17 return on every $1 invested
in early childhood programs. She also cited the Neal Study,
which found that 46 percent of children who receive early
intervention no longer need special education services by
kindergartenrepresenting a significant cost difference between
early intervention at approximately $8,000 per year and special
education at $30,000 per year.
3:51:27 PM
MS. SIMPSON moved to slide 8, Identify Earlier, a graph showing
the number of children, served by special education, October
2023. Students are categorized by age ranging from 3 to 21 years
old. She highlighted the significant impact of Alaska's
restricted eligibility for early intervention. She explained
that the limited number of three- and four-year-olds in
preschool special education is a direct result of the current 50
percent delay requirement, creating a gap where children are not
identified early enough. She pointed out that delays in
identifying students who need an Individualized Education
Program (IEP) in the school system led to higher costs.
Expanding eligibility would shift identification earlier,
allowing more children to access early intervention and
preschool services and reducing the future need for special
education. She emphasized that the data supports what
professionals already knowinvesting early is more effective and
cost-efficient than intervening later.
3:52:22 PM
MS. SIMPSON moved to slide 9, Invest Earlier, a graph titled
Public Spending and Brain Development the Disconnect. The graph
shows the portion of total public investment in children being
spent during the indicated year in children's lives. Public
spending is the highest when brain development has already
reached 100 percent. She said this slide shows what is already
known to be true; invest early and not late:
[Original punctuation provided.]
Invest Earlier
Almost 90 percent of brain development happens by age
3.
Children who don't receive ILP services, may not be
identified until Kindergarten.
Earlier services can lead to much greater impact!
3:52:33 PM
MS. SIMPSON moved to slide 10, which contained two graphs. The
first graph, Because of Restrictive Eligibility Alaska Trails
Behind Other States, shows the percentage of children in ILP
that achieve age typical development by age 3. The graph
compares Alaska, benchmark states, and the top five states. The
other graph, Substantial Savings That Can Be Used for Other
Education Needs, shows the costs savings that could occur by
implementing earlier intervention. She stated that child
outcomes data is important for evaluating early intervention
services across the country. She explained that the blue bars on
the slide represent the percentage of children who exit early
intervention at age-appropriate developmental levels, with
Alaska currently at 41 percent compared to the national average
of 46 percent. Benchmark states with similar eligibility
criteria are performing well above the national average, with
top-performing states reaching 65 percent, which she identified
as the goal for Alaska. She emphasized that achieving this
outcome would reduce the need for special education services and
lead to significant cost savings.
3:53:52 PM
MS. SIMPSON moved to slide 11, Challenges in Alaska. The slide
contains a graph showing how flat funding and inflation have
impacted program funding. She said that despite a growing need
and the impact of the global pandemic, early intervention
funding in Alaska has remained flat for over 11 years, resulting
in a 25 percent loss in value due to rising costs.
3:54:19 PM
MS. SIMPSON moved to slide 12, Take-Away: Invest in the People
of Alaska:
[Original punctuation provided.]
Take-Away: Invest in the People of Alaska
• Approve expanded eligibility and additional $5.7M
funding for AK ILP.
• Ensure all Alaskan children have equitable access
to early intervention services.
• ROI: Early intervention saves up to $229K per
child just in special education costs. Annual
cost savings up to $34.9M
MS SIMPSON concluded the presentation by supporting the proposed
eligibility expansion and the associated $5.7 million in
funding, emphasizing that early intervention can save up to
$230,000 per year in special education costs by ensuring
children are ready to learn.
3:55:05 PM
CHAIR DUNBAR referred to slide 6 and asked if it is possible to
make the change to Medicaid statute even if aligning Part C with
Part B of the Disabilities Education Act does not occur.
MS. SIMPSON replied yes that a Medicaid statute change alone
would have a similar positive effect in terms of creating shared
federal-state funding. However, she clarified that it would not
increase the number of children served, since eligibility rules
still limit enrollment. She emphasized that without expanding
eligibility, many children would remain ineligible for services
despite the funding mechanism
3:56:20 PM
CHAIR DUNBAR asked if it is possible to model the exact fiscal
impact of shifting some Medicaid costs to the federal program
and simultaneously calculate the cost increase associated with
each percentage point change in eligibility criteria. He stated
that he supports the investment but acknowledged the difficulty
of the current fiscal environment. He noted that while reaching
more children would increase costs, shifting expenses to the
federal level could offset them. He expressed interest in
determining whether these factors could bring the fiscal note to
zero.
3:57:08 PM
MS. SIMPSON stated that cost avoidance in special education
could help offset the increased costs of expanding early
intervention but expressed uncertainty about modeling precise
fiscal impacts. She noted that national consultants on Part C
support the 25 percent developmental delay threshold. She
emphasized that restructuring Medicaid would have a significant
impact in supporting home and community-based services which
come at a higher cost.
3:58:31 PM
SENATOR HUGHES asked:
• whether the $5.72 million funding request reflects the full
cost to the state without factoring in the 50/50 state-federal
Medicaid split. She expressed uncertainty about whether the
estimate already includes potential federal cost sharing. She
noted it sounded as though the amount might represent the full
state burden.
• whether changing Medicaid would require a change to state
statute or if the Department of Health would need to submit a
request for change to Medicaid, which could take additional
time. She sought clarification on the process involved in making
the proposed Medicaid changes.
• whether aligning it with Part B requires a statutory or
regulatory change, or if alignment could occur solely with the
availability of additional funding. She sought to understand
whether legislative action is necessary for the proposed
eligibility alignment.
3:59:49 PM
MS. SIMPSON responded that changing the Part C eligibility
criteria is handled through the Senior and Disabilities Services
Office through ILP at the state level. She clarified that this
change does not require additional funding, but without funding,
it would result in minimal contactsuch as seeing children only
once a yearwhich does not constitute true early intervention.
She deferred the remainder of the questions.
4:00:38 PM
HEIDI HAAS, Executive Director, Alaska Center for Children and
Adults (AACA), Fairbanks, Alaska, answered questions on
Expanding Eligibility for Alaska's Infant Learning Program. She
confirmed that the specific question asked was about the
processes required for the state to make changes in both
eligibility and billing. She explained that, from a billing
perspective, the state must establish a provider change to allow
Infant Learning Program (ILP) servicessuch as developmental
therapyto be billable under Medicaid. Currently, developmental
therapy is not reimbursable through Medicaid or any other
provider and is instead covered by state grant funds.
MS. HAAS emphasized the importance of updating Medicaid billing
codes to support services unique to ILP agencies, ensuring only
qualified providers can bill for these specialized services.
However, she cautioned that expanding eligibility without
corresponding financial support would be problematic. She stated
that the current $9 million in state funding functions more like
$6 million due to high operational costs, including extensive
travel by air, boat, snow machine, and car. As a result, billing
changes alone would not fully offset the increased costs of
expanding eligibility.
4:03:38 PM
SENATOR HUGHES clarified that she wanted to understand the role
of the legislature in the process. She asked whether a statute
change is required to implement billing code changes and
Medicaid provider agreements, or if those changes fall under the
Department of Health's authority and require a Medicaid state
plan amendment submitted to the Centers for Medicare & Medicaid
Services (CMS).
4:03:59 PM
MS. HAAS stated that a statute change is required to expand
eligibility in order to serve more children. She explained that
changes on the Medicaid side would likely involve regulatory
adjustments to allow for additional billing codes or the
creation of program-specific codes. She offered to confirm this
information and provide it to the committee, noting that while
she has a general understanding, staff from the state's Infant
Learning Program would have more detailed knowledge of the exact
processes involved.
4:04:46 PM
SENATOR HUGHES requested clarification on the specific steps
needed, particularly regarding eligibility and law change.
MS. HASS said it is correct that a law change is needed to
change eligibility.
4:05:00 PM
SENATOR TOBIN stated that she and her colleagues have been
working on legislation through the Alaska Children's Caucus and
identified this issue as a top priority based on stakeholder
feedback during their survey process. She noted that the topic
was also discussed during the summer and that legislation is
anticipated to address both service access and cost-saving
opportunities. She compared the intent to the Alaska Reads Act,
aiming to reduce long-term special education costs through early
intervention. She thanked the presenters and emphasized the
value of the information shared on this complex topic.
4:05:52 PM
MS. SIMPSON thanked the committee for their time and
acknowledged the challenges they face in balancing funding
priorities. She expressed appreciation for their work and
recognized the difficulty of being away from families while
doing it. She emphasized that investing in infants and toddlers
creates long-term benefits for them that will positively impact
the entire community.
4:06:22 PM
CHAIR DUNBAR acknowledged that some questions raised during the
discussion were difficult to answer immediately and invited
follow-up to his office or any committee member for
distribution. He expressed interest in receiving more detailed
information about what specific changes are required in statute
and regulation, as well as a clearer analysis of the fiscal
impact. He emphasized the importance of understanding how a
shift to a federal-state partnership model in Medicaid billing
could generate savings for the state. While he agreed that long-
term cost reductions are compelling, he stressed the
constitutional requirement to balance the budget annually and
noted the difficulty of making short-term investments without
clear near-term savings. He encouraged the presenters to
demonstrate any potential short-term savings that could support
the proposal.
4:07:29 PM
At ease.
SB 76-COMPLEX CARE RESIDENTIAL HOMES
4:08:37 PM
CHAIR DUNBAR announced the consideration of SENATE BILL NO. 76
"An Act relating to complex care residential homes; and
providing for an effective date."
4:08:51 PM
CHAIR DUNBAR opened public testimony on SB 76.
4:09:18 PM
KIM CHAMPNEY, Executive Director, Alaska Association on
Developmental Disabilities, Juneau, Alaska, testified in support
of SB 76. She stated that their 109 member organizations provide
home and community-based Medicaid waiver services to individuals
with developmental disabilities across the state. She described
a recurring cycle where individuals with complex behavioral
needs lose service providers, often following an incident, and
then cycle through hospitals or the Alaska Psychiatric Institute
(API) until another provider is foundfrequently one with
limited experience and inadequate resources. She emphasized that
these unstable transitions are traumatic for both individuals
receiving care, the direct support staff involved, and provider
organizations.
MS. CHAMPNEY expressed that the current system is not working
and acknowledged the need for a different approach to service
delivery. She affirmed AADD's support for SB 76, which she
described as a step toward developing a new type of residential
setting not currently available in Alaska. She added that AADD
looks forward to working with the Departments of Health and
Family and Community Services as service details are developed.
4:11:37 PM
DAVID WALLACE, Chief Executive Officer, Matsu Regional Medical
Center, Palmer, Alaska, testified in support of SB 76 and said
he spoke on behalf of the 1,000 employees at Mat-Su Regional
Medical Center. He described the case of a patient with dementia
who had ten emergency room visits due to unmanaged behavioral
health needs while residing at the Pioneer Home in Palmer. After
being discharged from the Pioneer Home and spending 50 days in
the emergency departmentdesigned for short-term carestaff
experienced distress and frustration over the lack of
appropriate placement options.
MR. WALLACE explained that despite extensive collaboration among
care teams, guardians, and state agencies, no suitable placement
could be found for weeks due to the complexity of the patient's
needs and limited licensed facilities. Eventually, a placement
was secured in a home appropriately licensed and staffed, which
he personally helped the patient transition into. He described
the new setting as ideal and commended the care team. He urged
support for SB 76, which he believes will help prevent similar
situations and ensure proper care for individuals with complex
needs.
4:16:27 PM
JARED KOSIN, President, Alaska Hospital and Healthcare
Association, Anchorage, Alaska, testified in support of SB 76 and
described the legislation as a necessary step to address a
chronic issue affecting Alaska's healthcare system. He reported
that, based on monthly hospital surveys, an increasing number of
patients remain in acute care settings despite no longer needing
hospitalization. This is due to a lack of appropriate post-acute
care placements. Patients are stuck in the most complex
expensive environment in the healthcare system. The hospitals
caring for them loose key resources without reimbursement. He
noted that these patients occupy one out of every seven hospital
beds in Alaska, resulting in over 43,500 additional hospital
days in 2023 alone. He emphasized that a major reason for the
created gridlock is the absence of services for individuals with
complex needs. He stated that SB 76 would create complex care
residential homes providing a more appropriate, lower-level care
setting in communities, helping to ease hospital overcrowding
and reduce unnecessary admissions. He urged the committee to
pass the SB 76 as a critical first step in expanding access to
care.
4:18:29 PM
PHILLIP TAFS, representing self, Anchorage, Alaska, testified in
support of SB 76. He said that as a consultant for the Complex
Behavior Collaborative (CBC) for over a decade, he emphasized
that creating a stable, well-trained complex care residential
home system is the most impactful step Alaska can take to
stabilize services for individuals with severe behavioral
challenges. He described a revolving door pattern between
hospitals, the Alaska Psychiatric Institute (API), out-of-state
placements, and waiver-funded homes unequipped to handle such
cases. He stated that this cycle is both financially costly and
deeply harmful to individuals, leading to behavioral
deterioration and reduced options for future transitions. He
cited longstanding research, including the original Western
Interstate Commission for Higher Education (WICHE) report, that
has consistently identified this gap in the system. He also
shared a recent tragic case of a young Alaskan who cycled
through six to seven placements in one year due to lack of
appropriate care and ultimately died, emphasizing that the cost
and human toll of the current system far exceed the cost of
building the right infrastructure. He strongly urged passage of
the SB 76 to address this urgent and unmet need.
4:21:27 PM
LUCY BAUER, Representative, Alaska Assisted Living Home
Association, Anchorage, Alaska, testified in support of SB 76.
She said she is a provider operating a large home in Anchorage
for residents with mental health conditions since 1999. She
described the challenges she regularly faces, including frequent
crises and threats, and stated that while she loves her work and
the people she serves, Alaska's mental health system is missing
a critical piece. She expressed hope that SB 76 will serve as a
vital bridge between hospitals and assisted living homes. She
shared a tragic example of a 29-year-old man placed in the
Department of Corrections (DOC). He required a higher level of
care, but no facility would accept him, and five days later, he
died in jail. She emphasized her 25 years of experience and
stressed the urgent need for a proper system to support
vulnerable adults. She thanked the Governor, the Department of
Health, and others supporting the bill, expressing optimism for
the positive changes SB 76 could bring.
4:23:54 PM
JAMIE ELKHILL, Vice President, Youth and Transitional Age Youth
(TAY) Services, Volunteers of America (VOA) Alaska, Eagle River,
Alaska, testified in support of SB 76. She emphasized that
complex care residential homes would provide a less restrictive,
stable, and supportive environment for youth, young adults, and
familiesreducing hospitalizations and out-of-state placements
while keeping individuals close to their support systems. She
shared that her organization, Volunteers of America Alaska (VOA
Alaska), regularly sees the effects of this gap, including youth
who relapse into substance use or self-destructive behavior due
to unstable post-treatment living environments. She noted that
during clinical reviews, 30 percent of youth ages 13 to 18 who
completed treatment relapsed due to lack of support, with actual
rates likely higher. She concluded that this legislation would
not only improve individual outcomes but also reduce strain on
other systems, such as hospitals, psychiatric facilities, the
Office of Children's Services, and the criminal justice system.
She urged the committee to support the SB 76, and other bills
like it, stating it address a long-standing need that will help
Alaskans with complex needs thrive in their communities.
4:27:57 PM
MICHELLE OVERSTREET, Chief Executive Officer, My House, Wasilla,
Alaska, testified in support of SB 76. She testified that Alaska
faces a dire need for supportive housing for individuals with
disabilities as they receive recovery services. She echoed the
concerns shared by Mr. Wallace and Ms. Elkhill, emphasizing that
this population needs structured support to heal and that the
current gap in housing leads to continued trauma and risk,
including death. She stated that while the proposed statutory
changes may carry a cost, the savings from reduced reliance on
crisis services and avoidance of additional harm would far
outweigh them. She shared that her organization serves youth
ages 14 to 24, many of whom are impacted by fetal alcohol
spectrum disorders (FAS/FASD), attention deficit hyperactivity
disorder (ADHD), traumatic brain injuries, and other behavioral
health and medical conditions. A significant number are trauma
survivors, including victims of incest, child rape, sexual
assault, domestic violence, and neglect. She described a
recurring pattern where clients cycle between emergency rooms,
residential care, inpatient treatment, and correctional settings
due to the lack of supportive housing at discharge. She gave the
example of a current client, an incest survivor, staying at a
shelter in Anchorage after spending three months in a behavioral
health unit, with no suitable placement available. She stated
that without housing support, this individual remains in danger
and struggles to maintain services. She expressed strong support
for SB 76, stating that the opportunity to establish this type
of housing could help save lives.
4:30:27 PM
CHAIR DUNBAR closed public testimony on SB 76.
4:31:20 PM
EMILY RICCI, Deputy Commissioner, Department of Health (DOH),
Juneau, Alaska, put herself on the record to answer questions on
SB 60.
4:31:30 PM
SENATOR HUGHES stated that the testimony provided made the need
for SB 76 clear, particularly in light of the risks of placing
individuals in inappropriate environments like jails or
hospitals. She emphasized the severity of consequences,
including the risk of death, when individuals with complex needs
are not placed in proper care settings. She questioned whether
the limit of 15 residents per home contained in SB 76 is
appropriate, especially given the testimony about increasing
need. While acknowledging that 15 residents may fill a large
home, she raised the possibility of multiple homes sharing
common areas, such as a courtyard, and asked if that would
require a different licensing approach. She requested
clarification on whether the 15-resident limit is based on
research or regulatory constraints and whether a higher number
could be considered if proper staffing ratios are maintained.
4:33:04 PM
MS. RICCI explained that the limit of 15 residents is tied to a
federal requirement related to Medicaid funding, specifically
the "Institution for Mental Disease" (IMD) exclusion. This
exclusion restricts how Medicaid dollars can be used for
facilities with 16 or more beds that serve individuals with
mental health conditions. She stated that to maintain
eligibility for Medicaid funding, residential long-term care
settings must remain under that 16-bed threshold. This
constraint is why the bill proposes a cap of 15 residents. She
added that other states with similar programs also commonly use
this limit for the same reason, even though program models vary.
4:34:11 PM
SENATOR HUGHES asked whether, under SB 76, multiple homes
clustered on a shared courtyard would each require separate
licenses, even if operated by a single business entity. She
assumed this could be the case and requested clarification. She
mentioned significant permitting delays for assisted living
homes, acknowledging that while this is a new license type,
similar issues could arise. She expressed hope that the
licensing process for complex care residential homes would be
more efficient and not take months to complete. She requested
information on the expected processing time for licensure under
SB 76 and confirmation that one business owner would be allowed
to operate multiple licensed homes.
4:35:10 PM
MS. RICCI responded that the specific licensure requirements for
complex care residential homes, including whether multiple homes
on a shared property can be operated by a single business, will
be promulgate regulation. She noted that careful design and
implementation will be necessary to ensure compliance with
federal requirements. She explained that while SB 76 allows for
homes with up to 15 beds, the Department anticipates tailoring
bed capacity through regulation based on the population served.
For example, smaller settings may be more appropriate for youth
or individuals with severe needs.
MS. RICCI said regarding concerns about licensing delays, she
clarified that assisted living home licensure is handled by the
Division of Health Care Services, which includes two sections
for licensing: one for health facilities (e.g., hospitals) and
another for residential licensing (e.g., assisted living homes).
She acknowledged that residential licensing faced significant
staffing shortages in FY24, with a vacancy rate between 29 and
31 percent. However, the Department has been working to fill
positions and, as of three weeks ago, residential licensing had
only one vacancy remaining. She said that while many team
members are new and still in training, improvements are underway
to speed up the licensing process. She added that SB 76, as
written, considers the licensing of complex care residential
homes to fall under the health facilities licensing and
certification sectiondistinct from the residential licensing
section that manages assisted living homes.
4:38:24 PM
CHAIR DUNBAR held SB 76 in committee.
4:38:37 PM
At ease.
SB 60-ESTABLISH ME/CHRONIC FATIGUE SYNDROME DAY
4:39:09 PM
CHAIR DUNBAR reconvened the meeting and announced the
consideration of SENATE BILL NO. 60 "An Act establishing May 12
as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Day of
Recognition."
4:39:29 PM
SENATOR HUGHES thanked Senator Tobin's office for presenting the
legislation because earlier recognition by states means better
chances for research and treatment.
4:40:01 PM
SENATOR TOBIN thanked the committee for taking the time to hear
the legislation and expressed appreciation for their support and
kind words to the testifiers who shared their stories.
4:40:15 PM
CHAIR DUNBAR solicited the will of the committee.
4:40:17 PM
SENATOR GIESSEL moved to report SB 60, work order LS-340070\I,
from committee with individual recommendations and attached
fiscal note(s).
4:40:28 PM
CHAIR DUNBAR found no objection and SB 60 was reported from the
Senate Health and Social Services Standing Committee.
4:41:16 PM
There being no further business to come before the committee,
Chair Dunbar adjourned the Senate Health and Social Services
Standing Committee meeting at 4:41 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| GCDSE.ICC Presentation 2025 Senate HSS 02-13-2025.pdf |
SHSS 2/13/2025 3:30:00 PM |
GCDSE.ICC Presentation 2025 Senate HSS 02-13-2025 |
| CSS LOS HB73 and SB76 2-6-25 (v.2 corrected).pdf |
SHSS 2/13/2025 3:30:00 PM |
HB 73 SB 76 |
| SB 76 CPH Letter of Support 2.12.25.pdf |
SHSS 2/13/2025 3:30:00 PM |
SB 76 |
| SB 76 LoS Foundation Health Partners 2.6.25.pdf |
SHSS 2/6/2025 3:30:00 PM SHSS 2/13/2025 3:30:00 PM |
SB 76 |
| SB76 LOS VOA 2.11.25.pdf |
SHSS 2/13/2025 3:30:00 PM |
SB 76 |