SB 58: "An Act establishing an in-home and community-based services program for certain adults with long-term care needs; and providing for an effective date."

00SENATE BILL NO. 58 01 "An Act establishing an in-home and community-based services program for 02 certain adults with long-term care needs; and providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. FINDINGS AND POLICY RELATED TO SECTION 2. (a) Regarding sec. 05 2 of this Act, the legislature finds that 06 (1) many elderly, chronically ill, or other physically or cognitively impaired 07 adults in Alaska have long-term care needs and would benefit from the availability of a wider 08 range of in-home and community-based services; 09 (2) currently the long-term care needs often go unmet or require the adult to 10 seek services in an institutional setting when in-home or community-based services could 11 provide a more appropriate and less costly level of care; 12 (3) expanding the availability of in-home or community-based services would 13 allow adults to maintain their independence longer, maximize the adult's or family's resources 14 to provide essential care and perhaps avoid or reduce state expenditures for care, and avoid

01 potential emotional and social problems that can result from an adult having to relocate to an 02 institution hundreds of miles away from family or friends; 03 (4) currently, in-home and community-based services are not readily available 04 in many parts of Alaska and, where they do exist, the adults and families who would benefit 05 from the services are unaware of their availability or lack resources to procure them without 06 some state assistance; 07 (5) Alaskans would benefit by having a system of long-term care assessment 08 and care coordination to improve access to and understanding of appropriate in-home and 09 community-based services. 10 (b) Regarding sec. 2 of this Act, the legislature declares that it is the policy of the 11 state to 12 (1) increase the availability of in-home and community-based services for 13 elderly, chronically ill, or physically or cognitively impaired adults with long-term care needs; 14 (2) give priority for in-home and community-based services to those adults 15 described in (1) of this subsection who are at the greatest risk of being, or who already have 16 been, placed in a care setting that may be more restrictive than the adult wishes or requires; 17 and 18 (3) encourage a variety of agencies, facilities, and individuals to provide in- 19 home and community-based services in the state. 20 * Sec. 2. AS 47.24 is amended by adding new sections to read: 21 Article 2. In-Home and Community-Based Services Program for 22 Medically, Physically, or Cognitively Impaired Adults. 23  Sec. 47.24.200. In-home and community-based services program for 24 medically, physically, or cognitively impaired adults. (a) There is created in the 25 department a program to administer, coordinate, and deliver or to award grants or 26 contracts for the delivery of in-home and community-based services for adults eligible 27 for services under AS 47.24.200 - 47.24.290. The program may serve only the adults 28 who are eligible for the program. 29  (b) The expenditures incurred under (a) of this section may not exceed the 30 appropriations available for the program. 31  (c) The department may adopt regulations necessary to implement, interpret,

01 or otherwise carry out the purposes of AS 47.24.200 - 47.24.290. Notwithstanding the 02 provisions of AS 47.24.200 - 47.24.290, the regulations adopted may further define, 03 limit, or assign priorities to adults eligible for the services and define, limit, or assign 04 priorities to services to be provided as necessary to fulfill program objectives or as 05 necessary to ensure that program expenditures will not exceed appropriations available 06 for the program. 07  Sec. 47.24.205. Adults to be served. An adult is eligible for services under 08 AS 47.24.200 - 47.24.290 if the department determines that 09  (1) the adult has a long-term care need; 10  (2) the adult's need for services is because of medical, physical, or 11 cognitively functional impairment; 12  (3) the adult's limitations restrict the ability to carry out the normal 13 activities of daily living and to live independently; and 14  (4) the adult meets the requirements of AS 47.24.200 - 47.24.290 and 15 the regulations adopted under those provisions. 16  Sec. 47.24.210. Eligibility for services. An adult who meets the requirements 17 of AS 47.24.205 is eligible for services under AS 47.24.200 - 47.24.290 if the adult 18  (1) is at risk of being or already has been placed in a setting providing 19 services more restrictive than is necessary to meet the adult's needs or more restrictive 20 than the adult would choose; 21  (2) has long-term care needs that can be met through in-home and 22 community-based services; 23  (3) has insufficient personal income and assets to pay for services 24 needed; and 25  (4) has needs that cannot be met from other available support, including 26 family members, neighbors, or public service agencies. 27  Sec. 47.24.215. Eligible services and places of delivery. (a) The department 28 may pay for or provide only in-home and community-based services and care 29 coordination that enable an eligible adult to remain at home or in a less restrictive care 30 setting than that provided in an institutional setting. The department shall, by 31 regulation, specify the types of care, care coordination, and health, social, and other

01 assistance that are eligible services under this section. 02  (b) The department may not authorize payment from the program to replace 03 or augment state-administered programs for in-home and community-based services 04 for adults. 05  (c) The department may not authorize payment from the program for the 06 following services: 07  (1) intermediate or skilled care provided by a nursing facility or 08 hospital licensed under AS 18.20; or 09  (2) services provided in the Alaska Pioneers' Home under AS 47.55. 10  (d) The department may adopt regulations to grant waivers from the provisions 11 of (c) of this section if the department finds that the services are necessary on a short- 12 term basis to allow the adult to remain at home or in a less restrictive care setting than that 13 described in (c) of this section. 14  Sec. 47.24.220. Delivery of services. (a) The department may use its own 15 staff or enter into agreements, grants, or contracts to administer the program or to 16 provide eligible services. 17  (b) The department shall solicit proposals from providers to provide services 18 under AS 47.24.205 - 47.24.240. An interested provider shall submit its proposal in 19 a form and manner as required by the department. An entity, an agency, a facility, a 20 local government, or an individual intending to offer services under AS 47.24.200 - 21 47.24.290 is eligible to submit a proposal to the department to provide eligible 22 services. The department may enter into an agreement or award a contract or grant 23 if the proposal meets the requirement of AS 47.24.200 - 47.24.290 and furthers the 24 purposes of the program. 25  (c) In areas not served by a provider selected by the department, the 26 department may provide services through individual agreements, grants, or contracts 27 to meet the needs of eligible adults. 28  (d) The department may use demonstration projects to test new approaches to 29 in-home and community-based services in limited areas in the state. 30  Sec. 47.24.225. Responsibilities. (a) An adult receiving services under the 31 program shall contribute a copayment towards the cost of care and apply for, cooperate

01 with, and seek payment from other sources as required by the department for which 02 the adult is eligible for the same services. 03  (b) The department shall establish in regulation a schedule for copayments 04 under this section. The schedule must vary on a sliding scale based on 05  (1) the adult's net income and readily available assets; 06  (2) the other uncovered expenses needed to meet the adult's medical 07 and social needs; and 08  (3) the costs to the department of the services. 09  (c) The department may waive a requirement of this section if the department 10 determines that it is not cost effective to require conformance or if the waiver is in the 11 public interest. 12  Sec. 47.24.230. Collection from third-party payors. (a) If the department 13 pays for or provides services or assistance under the program to an adult eligible for 14 third-party payments for those services or assistance, the department may seek and 15 recover the payments on behalf of the adult to offset program expenditures. An adult 16 receiving services or assistance under the program is considered to have assigned to 17 the state, through the department, all rights to accrued and continuing payment 18 obligations that the adult may have from the third-party payors. 19  (b) If the department determines that it is feasible, the department may require 20 that a provider seek and recover payment from insurance or other third-party payor 21 before seeking payment from the department for the services under the program. 22  Sec. 47.24.235. Comprehensive data system. The department shall develop 23 and implement a comprehensive data system that tracks in-home and community-based 24 services, expenditures, services, consumer profiles, and consumer preferences. The 25 department shall seek to coordinate and to share data with other state and local 26 agencies or organizations. 27  Sec. 47.24.240. Assessment and care coordination services. The department 28 may implement a system of long-term care assessment and care coordination to 29 minimize administrative costs, improve access to appropriate services, and minimize 30 obstacles to the delivery of in-home and community-based services to adults eligible 31 for services under the program.

01  Sec. 47.24.245. Confidentiality and access to records. Medical, social, and 02 other client records received or developed under AS 47.24.200 - 47.24.290 are 03 confidential and are not open to public inspection or copying except as provided in 04 regulations of the department to further the purposes of the program or to better 05 coordinate care and services. Nothing in this section prohibits the department from 06 releasing nonidentifying information in aggregate form for research or other purposes. 07  Sec. 47.24.290. Definitions. In AS 47.24.200 - 47.24.290, 08  (1) "program" means the in-home and community-based services 09 program for medically, physically, or cognitively impaired adults under AS 47.24.200 - 10 47.24.290; 11  (2) "provider" means an entity, an agency, a facility, or an individual 12 providing services under AS 47.24.200 - 47.24.290; 13  (3) "services" means in-home and community support services provided 14 under AS 47.24.200 - 47.24.290. 15 * Sec. 3. AS 08.63.200(b) is amended to read: 16  (b) Notwithstanding (a) of this section, a person licensed under this chapter 17 shall report incidents of 18  (1) child abuse or neglect as required by AS 47.17; 19  (2) harm or assaults suffered by an elderly person or disabled adult as 20 required by AS 47.24.010 [AS 47.24]. 21 * Sec. 4. AS 47.05.017(b) is amended to read: 22  (b) The department shall adopt regulations identifying actions that it will take, 23 in addition to those otherwise required under AS 47.17 and AS 47.24.010 - 47.24.130 24 [AS 47.24], when a report of harm is made under AS 47.17 or AS 47.24.010 25 [AS 47.24] that might relate to harm caused by actions or inactions of a public home 26 care provider. The regulations must 27  (1) address circumstances under which the department will, or will 28 require a contractor or grantee to, reassign, suspend, or terminate a person alleged to 29 have perpetrated harm; 30  (2) include appropriate procedural safeguards to protect the due process 31 rights of public home care providers who may be reassigned, suspended, or terminated

01 under the circumstances described in (1) of this subsection; and 02  (3) if the home care provider is a certified nurse aide, include 03 procedures under which the department shall notify the Board of Nursing if the nurse 04 aide is suspected of abuse, neglect, or misappropriation of property. 05 * Sec. 5. AS 47.24.011 is amended to read: 06  Sec. 47.24.011. Duties of the department regarding services and protection 07 for vulnerable adults. In order to facilitate the provision of supportive and protective 08 services for vulnerable adults, the department shall 09  (1) compile information on available supportive and protective services 10 for vulnerable adults in the state; 11  (2) establish, publicize, and maintain a central information and referral 12 service for vulnerable adults; 13  (3) develop and coordinate a statewide system to serve vulnerable 14 adults who are in need of protective services; 15  (4) establish criteria and procedures for the authorization and 16 supervision of other state agencies or community-based service providers to serve as 17 designees of the department under AS 47.24.010 - 47.24.130 [THIS CHAPTER]; 18  (5) in accordance with AS 47.24.010 - 47.24.130 [THIS CHAPTER], 19 designate other state agencies or community-based service providers to deliver 20 supportive and protective services to vulnerable adults who are in need of protective 21 services; 22  (6) develop within the central information and referral service for 23 vulnerable adults a central registry for reports of vulnerable adults in need of protective 24 services; 25  (7) maintain confidentiality of records as provided for in AS 47.24.050; 26 and 27  (8) adopt regulations to carry out the purposes of AS 47.24.010 - 28 47.24.130 [THIS CHAPTER]. 29 * Sec. 6. AS 47.24.050(a) is amended to read: 30  (a) Investigation reports and reports of the abandonment, exploitation, abuse, 31 neglect, or self-neglect of a vulnerable adult filed under AS 47.24.010 - 47.24.130

01 [THIS CHAPTER] are confidential and are not subject to public inspection and 02 copying under AS 09.25.110 - 09.25.125. However, in accordance with AS 47.24.010 03 - 47.24.130 [THIS CHAPTER] and regulations adopted under AS 47.24.010 - 04 47.24.130 [THIS CHAPTER], investigation reports may be used by appropriate 05 agencies or individuals inside and outside the state, in connection with investigations 06 or judicial proceedings involving the abandonment, exploitation, abuse, neglect, or self- 07 neglect of a vulnerable adult. 08 * Sec. 7. AS 47.24.070 is amended to read: 09  Sec. 47.24.070. Required review of proposed regulations. Before adoption 10 by the department, regulations to implement AS 47.24.010 - 47.24.130 [THIS 11 CHAPTER] shall be provided to the Alaska Commission on Aging established under 12 AS 44.21.200 for review. 13 * Sec. 8. AS 47.24.130 is amended to read: 14  Sec. 47.24.130. Treatment through spiritual means. Nothing in 15 AS 47.24.010 - 47.24.130 [THIS CHAPTER] may [NOT] be construed to mean that 16 a person is abused, neglected, self-neglected, vulnerable, unable to consent, abandoned, 17 exploited, or in need of emergency or protective services for the sole reason that the 18 person relies on or is being furnished treatment by spiritual means through prayer 19 alone in accordance with the tenets and practices of a church or religious denomination 20 of which the person is a member or adherent, provided that the person consents to the 21 treatment through spiritual means only and the treatment is administered by an 22 accredited practitioner of the church or religious denomination. In this section, "church 23 or religious denomination" has the meaning given to "religious organization" in 24 AS 05.15.210. 25 * Sec. 9. This Act takes effect immediately under AS 01.10.070(c).