SSSB 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 SPONSOR SUBSTITUTE FOR 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 by 04 teleconference or other electronic means. At each meeting, the board shall provide 05 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 data, 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 Sec. 44.29.935. Biennial report. (a) The board shall biennially prepare a 14 written report in digital format, submit the report to the commissioner, the legislative 15 committees having jurisdiction over health and social services, and the chief clerk of 16 the house of representatives and the senate secretary, and notify the legislature that the 17 report is available. The commissioner shall make the report available to the public on 18 the department's Internet website. 19 (b) The biennial report must be based on the results of the board's 20 investigation under AS 44.29.930(a)(2) and must include key findings and 21 recommendations regarding 22 (1) rates and service levels of covered services; 23 (2) adequacy of rates and service levels of covered services to ensure 24 the provision of quality services, improved recruitment and retention, and compliance 25 with federal standards; 26 (3) safe and healthy working conditions for workers providing covered 27 services; 28 (4) reducing any barrier to recruiting for and retaining workers 29 providing covered services throughout the state, particularly in an area that is not on a 30 road system; 31 (5) reducing the level of unpaid care in the state and systemic
01 overreliance on family members and friends of service recipients who provide unpaid 02 care; and 03 (6) sufficiency of covered services payment adequacy data and access 04 to care metrics. 05 (c) The department shall take the recommendations of the board into 06 consideration when setting rates for covered services. If the rate set by the department 07 for a covered service differs significantly from the rate recommended by the board, the 08 commissioner shall notify the board and the chair of each legislative committee having 09 jurisdiction of health and social services in writing. 10 Sec. 44.29.945. Definitions. In AS 44.29.900 - 44.29.945, 11 (1) "board" means the Home Care Employment Standards Advisory 12 Board; 13 (2) "commissioner" means the commissioner of health; 14 (3) "covered provider" means an eligible Medicaid provider certified 15 by the department to provide one or more covered services; 16 (4) "covered services" means 17 (A) chore services provided under a section 1915(k) option 18 under 42 U.S.C. 1396n; 19 (B) hourly respite services provided under a waiver in 20 accordance with 42 U.S.C. 1396 - 1396p; 21 (C) personal care services; 22 (D) habilitation services; 23 (5) "department" means the Department of Health; 24 (6) "direct care worker" means an individual who is employed by a 25 covered provider to provide one or more covered services; 26 (7) "habilitation services" means services designed to assist individuals 27 in acquiring, retaining, and improving the self-help, socialization, and adaptive skills 28 necessary to reside successfully in home and community-based settings, provided 29 under a waiver in accordance with 42 U.S.C. 1396 - 1396p; 30 (8) "personal care services" means services provided under a section 31 1915(k) option under 42 U.S.C. 1396n, under AS 47.07.030, or under a waiver in
01 accordance with 42 U.S.C. 1396 - 1396p. 02 * Sec. 2. AS 47.07.045 is amended by adding new subsections to read: 03 (f) Except as provided in (g) of this section, an agency providing home and 04 community-based services shall pay as compensation and benefits to its employees 05 performing personal care services, 06 (1) beginning July 1, 2026, at least 70 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, 2030, at least 80 percent of the total annual 10 amount of funding the agency receives for personal care services from the department. 11 (g) The department may grant to an agency providing home and community- 12 based services a hardship exemption from the requirements of (f) of this section if the 13 agency is facing extraordinary circumstances or is a small provider, as defined by the 14 department. The department shall adopt regulations establishing procedures and 15 objective criteria for granting a hardship exemption under this subsection. An agency 16 that is granted a hardship exemption shall pay as compensation and benefits to its 17 employees performing personal care services, 18 (1) beginning July 1, 2026, at least 60 percent of the total annual 19 amount of funding the agency receives for personal care services from the department; 20 and 21 (2) beginning July 1, 2036, at least 80 percent of the total annual 22 amount of funding the agency receives for personal care services from the department. 23 (h) The amount calculated under (f) and (g) of this section for compensation 24 and benefits paid to employees may not include costs expended on employees by an 25 agency for personal protective equipment, required training, and travel costs such as 26 mileage reimbursement or public transportation. 27 (i) In this section, "personal care services" has the meaning given in 28 AS 44.29.945. 29 * Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to 30 read: 31 APPOINTMENTS, FIRST MEETING, AND PRELIMINARY REPORT. (a) The first
01 meeting of the Home Care Employment Standards Advisory Board established under 02 AS 44.29.900, added by sec. 1 of this Act, must take place on or before October 1, 2025. 03 (b) The commissioner of health shall appoint all board members under 04 AS 44.29.905(3), added by sec. 1 of this Act, before the board's first meeting. 05 (c) The commissioner of health or the commissioner's designee and the commissioner 06 of labor and workforce development or the commissioner's designee shall conduct a 07 preliminary investigation into the wages, working conditions, and adequacy of the Medicaid 08 workforce providing covered services in the state and present the results of the preliminary 09 investigation to the board at the board's first meeting. 10 * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to 11 read: 12 MEDICAID STATE PLAN. To the extent necessary to implement this Act, the 13 Department of Health shall amend and submit for approval by the United States Department 14 of Health and Human Services the state plan under AS 47.07.045, as amended by sec. 2 of 15 this Act. 16 * Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to 17 read: 18 CONDITIONAL EFFECT; NOTIFICATION. (a) Section 2 of this Act takes effect 19 only if, and to the extent that, on or before January 1, 2026, the United States Department of 20 Health and Human Services 21 (1) approves amendments submitted in accordance with sec. 4 of this Act; or 22 (2) determines that approval of the amendments to the state plan under 23 AS 47.07.045 is not necessary. 24 (b) The commissioner of health shall notify the revisor of statutes in writing within 30 25 days after the United States Department of Health and Human Services approves amendments 26 to the state plan or determines that approval is not necessary under this section. 27 * Sec. 6. If sec. 2 of this Act takes effect, it takes effect on the day after the date on which 28 the United States Department of Health and Human Services approves the amendments to the 29 state plan submitted under sec. 4 of this Act or determines that approval is not necessary 30 under sec. 5 of this Act. 31 * Sec. 7. Except as provided in sec. 6 of this Act, this Act takes effect July 1, 2025.