SB 154: "An Act establishing the Home Care Employment Standards Advisory Board; relating to payment for personal care services; and providing for an effective date."
00 SENATE BILL NO. 154 01 "An Act establishing the Home Care Employment Standards Advisory Board; relating 02 to payment for personal care services; and providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 44.29 is amended by adding new sections to read: 05 Article 10. Home Care Employment Standards Advisory Board. 06 Sec. 44.29.900. Home Care Employment Standards Advisory Board. The 07 Home Care Employment Standards Advisory Board is established in the department. 08 Sec. 44.29.905. Composition of the board. The board consists of 09 (1) the commissioner of health or the commissioner's designee, who 10 shall serve as the chair and is a nonvoting member, except in the case of a tie; 11 (2) the commissioner of labor and workforce development or the 12 commissioner's designee, who is a nonvoting member; and 13 (3) eight members appointed by the commissioner of health, as 14 follows:
01 (A) two voting members who represent covered providers, 02 including at least one agency that provided at least 700,000 units of personal 03 care services during the previous calendar year and one agency that provides 04 habilitation services; 05 (B) two voting members who represent direct care workers, at 06 least one of whom is a labor representative of at least 300 direct care workers; 07 a member appointed under this subparagraph may not be a representative of an 08 organization or association that advocates for the interests of covered providers 09 or agencies that provide covered services; 10 (C) one voting member who is an enrollee or a representative 11 of enrollees receiving covered services; 12 (D) one voting member who represents the office within the 13 department with responsibility for rate review; 14 (E) one nonvoting member who represents the Alaska 15 Commission on Aging or another organization that represents seniors in the 16 state; and 17 (F) one nonvoting member who represents the Governor's 18 Council on Disabilities and Special Education established under AS 44.29.600 19 or another organization that represents people with disabilities in the state. 20 Sec. 44.29.910. Term of office, vacancies, and removal of appointed 21 members. (a) The members of the board appointed under AS 44.29.905(3) serve two- 22 year terms and may be reappointed. 23 (b) A member of the board appointed under AS 44.29.905(3) serves at the 24 pleasure of the commissioner, except that the commissioner shall remove a member 25 who no longer meets the qualifications of the seat for which the member was 26 appointed. 27 (c) The commissioner may appoint an individual to fill a vacancy under 28 AS 44.29.905(3) only after providing public notice of the vacancy and soliciting 29 applications for the appointment. The commissioner shall fill the vacancy within six 30 months after the date the vacancy occurs. An appointment to fill the vacancy is for the 31 remainder of the unexpired term.
01 Sec. 44.29.915. Meetings. The board shall meet at the call of the chair. The 02 board shall meet at least three times each year and shall hold additional meetings as 03 often as necessary to accomplish the duties of the board. A meeting may be held in 04 person or by teleconference or other electronic means. At each meeting, the board 05 shall provide time for public testimony. 06 Sec. 44.29.920. Quorum. A majority of the voting members of the board 07 constitute a quorum for the transaction of business, and a majority of a quorum present 08 at a meeting is sufficient to approve a recommendation of the board. 09 Sec. 44.29.925. Compensation. Members of the board receive no 10 compensation for service on the board but are entitled to per diem and travel expenses 11 authorized for boards and commissions under AS 39.20.180. 12 Sec. 44.29.930. Powers and duties of the board. (a) The board shall 13 (1) advise and consult with the department on the medical assistance 14 program payment rates for covered services and payment rate adequacy and 15 compliance with federal requirements regarding reporting of payment adequacy data; 16 (2) investigate matters related to the wages, working conditions, and 17 workforce adequacy of workers providing covered services in the state, including 18 (A) the adequacy of wages, benefits, and other compensation to 19 ensure the provision of quality services and sufficient levels of recruitment and 20 retention; 21 (B) the sufficiency of levels of recruitment for and retention of 22 workers, particularly in an area that is not on a road system; 23 (C) the sufficiency of service levels of and the effect of service 24 level reductions on covered services, as the services pertain to wages and 25 working conditions; 26 (D) the adequacy and enforcement of training requirements; 27 (E) the effect of workforce shortages on service recipients and 28 on family members and friends of service recipients providing unpaid care, 29 including compliance with federal requirements to report information to the 30 United States Department of Health and Human Services, Centers for 31 Medicare and Medicaid Services, regarding wait times for covered services
01 and the percentage of authorized hours for covered services; 02 (F) the economic impact of achieving a living wage for direct 03 care workers and reducing levels of unpaid care; 04 (G) the adequacy of payment practices and policies related to 05 the payment rates of certified providers of covered services; and 06 (H) the effect of the state's long-term care system on wages and 07 working conditions. 08 (b) A state agency that receives a reasonable request for information or 09 testimony from the board shall comply with the request as soon as is reasonably 10 practicable, and, when the board requests direct testimony for a board meeting, the 11 head of the agency or the designee of the head of the agency shall appear at the 12 meeting and provide testimony. 13 (c) The department shall ensure the board has access to current and proposed 14 payment rates, payment adequacy reporting information for covered services that is 15 provided by the state to the United States Department of Health and Human Services, 16 Centers for Medicare and Medicaid Services, as required by federal law, and access to 17 metrics created by the state that contain information regarding wait times for covered 18 services and the percentage of authorized hours for covered services. 19 Sec. 44.29.935. Biennial report. (a) The board shall biennially prepare a 20 written report, submit the report to the commissioner, the legislative committees 21 having jurisdiction over health and social services, and the chief clerk of the house of 22 representatives and the senate secretary, and notify the legislature that the report is 23 available. The commissioner shall make the report and all materials presented before 24 the board available to the public on the department's Internet website. 25 (b) The biennial report must be based on the results of the board's 26 investigation under AS 44.29.930(a)(2) and must include key findings and 27 recommendations regarding 28 (1) rates and service levels of covered services; 29 (2) adequacy of rates and service levels of covered services to ensure 30 the provision of quality services, improved recruitment and retention, and compliance 31 with federal standards;
01 (3) safe and healthy working conditions for workers providing covered 02 services; 03 (4) reducing any barrier to recruiting for and retaining workers 04 providing covered services throughout the state, particularly in an area that is not on a 05 road system; 06 (5) reducing the level of unpaid care in the state and systemic 07 overreliance on family members and friends of service recipients who provide unpaid 08 care; and 09 (6) sufficiency of covered services payment adequacy data and access 10 to care metrics. 11 (c) Upon receiving the biennial report, the commissioner shall review the 12 board's findings and recommendations. The commissioner may 13 (1) accept or reject a recommendation; and 14 (2) require the board to conduct new or further investigations and 15 develop new recommendations. 16 (d) If the commissioner accepts a recommendation in the biennial report, the 17 department shall adopt regulations necessary to implement the recommendation. If the 18 commissioner rejects a recommendation in the biennial report, the commissioner shall 19 provide a written explanation of the commissioner's decision to all board members and 20 the legislative committees having jurisdiction over health and social services. If the 21 reason for rejection includes budgetary constraints, the commissioner shall work with 22 the Office of the Governor and the legislature to develop a budget proposal that would 23 allow the commissioner to accept the recommendation. 24 Sec. 44.29.940. Publication of reports. On July 1 of each year, or within 30 25 days after receiving the biennial report from the board, the department shall publish on 26 the department's publicly available Internet website an annual report containing the 27 weighted average of and median hourly wages, by agency, for workers providing 28 covered services. 29 Sec. 44.29.945. Definitions. In AS 44.29.900 - 44.29.945, 30 (1) "board" means the Home Care Employment Standards Advisory 31 Board;
01 (2) "commissioner" means the commissioner of health; 02 (3) "covered provider" means an eligible Medicaid provider enrolled 03 with the department to provide one or more covered services; 04 (4) "covered services" means 05 (A) chore services provided under a section 1915(k) option 06 under 42 U.S.C. 1396n; 07 (B) hourly respite services provided under a waiver in 08 accordance with 42 U.S.C. 1396 - 1396p; 09 (C) personal care services; 10 (D) habilitation services; 11 (5) "department" means the Department of Health; 12 (6) "direct care worker" means an individual who is employed by a 13 covered provider to provide one or more covered services; 14 (7) "habilitation services" means services designed to assist individuals 15 in acquiring, retaining, and improving the self-help, socialization, and adaptive skills 16 necessary to reside successfully in home and community-based settings, provided 17 under a waiver in accordance with 42 U.S.C. 1396 - 1396p; 18 (8) "personal care services" means services provided under a section 19 1915(k) option under 42 U.S.C. 1396n, under AS 47.07.030, or under a waiver in 20 accordance with 42 U.S.C. 1396 - 1396p. 21 * Sec. 2. AS 47.07.045 is amended by adding new subsections to read: 22 (f) Except as provided in (g) of this section, an agency providing home and 23 community-based services shall pay as compensation and benefits to its employees 24 performing personal care services, 25 (1) beginning July 1, 2026, at least 70 percent of the total annual 26 amount of funding the agency receives for personal care services from the department; 27 and 28 (2) beginning July 1, 2030, at least 80 percent of the total annual 29 amount of funding the agency receives for personal care services from the department. 30 (g) The department may grant to an agency providing home and community- 31 based services a hardship exemption from the requirements of (f) of this section if the
01 agency is facing extraordinary circumstances or is a small provider, as defined by the 02 department. The department shall adopt regulations establishing procedures and 03 objective criteria for granting a hardship exemption under this subsection. An agency 04 that is granted a hardship exemption shall pay as compensation and benefits to its 05 employees performing personal care services, 06 (1) beginning July 1, 2026, at least 60 percent of the total annual 07 amount of funding the agency receives for personal care services from the department; 08 and 09 (2) beginning July 1, 2036, at least 80 percent of the total annual 10 amount of funding the agency receives for personal care services from the department. 11 (h) The amount calculated under (f) and (g) of this section for compensation 12 and benefits paid to employees may not include costs expended on employees by an 13 agency for personal protective equipment, required training, and travel costs such as 14 mileage reimbursement or public transportation. 15 (i) In this section, "personal care services" has the meaning given in 16 AS 44.29.945. 17 * Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to 18 read: 19 APPOINTMENTS, FIRST MEETING, AND PRELIMINARY REPORT. (a) The first 20 meeting of the Home Care Employment Standards Advisory Board established under 21 AS 44.29.900, added by sec. 1 of this Act, must take place on or before October 1, 2025. 22 (b) The commissioner of health shall appoint all board members under 23 AS 44.29.905(3), added by sec. 1 of this Act, before the board's first meeting. 24 (c) The commissioner of health or the commissioner's designee and the commissioner 25 of labor and workforce development or the commissioner's designee shall conduct a 26 preliminary investigation into the wages, working conditions, and adequacy of the Medicaid 27 workforce providing covered services in the state and present the results of the preliminary 28 investigation to the board at the board's first meeting. 29 * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to 30 read: 31 PRELIMINARY INTERNET WEBSITE PUBLICATION. Notwithstanding
01 AS 44.29.940, added by sec. 1 of this Act, the Department of Health shall make the first 02 publication of the reports required by AS 44.29.940, added by sec. 1 of this Act, on the 03 department's Internet website not later than July 1, 2026. 04 * Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to 05 read: 06 MEDICAID STATE PLAN. To the extent necessary to implement this Act, the 07 Department of Health shall amend and submit for approval by the United States Department 08 of Health and Human Services the state plan under AS 47.07.045, as amended by sec. 2 of 09 this Act. 10 * Sec. 6. The uncodified law of the State of Alaska is amended by adding a new section to 11 read: 12 CONDITIONAL EFFECT; NOTIFICATION. (a) Section 2 of this Act takes effect 13 only if, and to the extent that, on or before January 1, 2026, the United States Department of 14 Health and Human Services 15 (1) approves amendments submitted in accordance with sec. 5 of this Act; or 16 (2) determines that approval of the amendments to the state plan under 17 AS 47.07.045 is not necessary. 18 (b) The commissioner of health shall notify the revisor of statutes in writing within 30 19 days after the United States Department of Health and Human Services approves amendments 20 to the state plan or determines that approval is not necessary under this section. 21 * Sec. 7. If sec. 2 of this Act takes effect, it takes effect on the day after the date on which 22 the United States Department of Health and Human Services approves the amendments to the 23 state plan submitted under sec. 5 of this Act or determines that approval is not necessary 24 under sec. 6 of this Act. 25 * Sec. 8. Except as provided in sec. 7 of this Act, this Act takes effect July 1, 2025.