Legislature(2023 - 2024)ADAMS 519
04/12/2023 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB58 | |
| HB59 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | HB 58 | TELECONFERENCED | |
| + | HB 59 | TELECONFERENCED | |
| + | TELECONFERENCED |
HOUSE BILL NO. 58
"An Act relating to medical assistance for recipients
of Medicaid waivers; establishing an adult care home
license and procedures; providing for the transition
of individuals from foster care to adult home care
settings; and providing for an effective date."
1:36:52 PM
TONY NEWMAN, ACTING DIRECTOR, DIVISION OF SENIOR AND
DISABILITIES SERVICES, DEPARTMENT OF HEALTH, explained that
the bill would add to the array of services under the
Medicaid Home and Community Based Waiver Program. He
provided a PowerPoint presentation titled "State of Alaska
Department of Health: House Bill 58: Adult Home Care,"
dated April 4, 2023.
1:37:47 PM
Mr. Newman turned to slide 2 titled Senior and
Disabilities Services Medicaid Home and Community Based
Waivers:
• Allow people with disabilities and seniors to remain
in their homes or local community settings when they
would otherwise need institutional care.
• Home and Community Based Waivers receive a 50%
Federal and 50% General Fund Match
• Alaska provides five home and community-based
waivers:
1. Intellectual and Developmental Disabilities
waiver (serving about 2,000 people)
2. Alaskans Living Independently waiver (2,200
people)
3. Children with Complex Medical Conditions
waiver (225 people)
4. Adults with Physical & Developmental
Disabilities waiver (144 people)
5. Individualized Supports waiver (500 people)
1:39:20 PM
Mr. Newman provided examples of the types of Alaskans
served by waivers. He exemplified that the first type of
waiver would serve a senior who suffered a stroke that
resulted in permanent limited mobility. The second waiver
would serve someone with cerebral palsy or a disabled
person able to live at home with support. He interjected
that waivers provided people with more independence and
personal choice as well as saved the state significant
amounts of money that would otherwise be spent on
institutional care. He turned to slide 3 titled Services
Available Under Alaska's Medicaid Home and Community-Based
Waivers:
Residential Habilitation (Group Home, Family Home
Habilitation)
In-Home Supports
Supported Living
Day Habilitation
Ault Day Services
Respite
Supported Employment
• Transportation
• Environmental Modifications
• Meals
• Specialized Medical Equipment
• Nursing Oversight
• Intensive Active Treatment
• Specialized Private Duty Nursing
and Care Coordination
Mr. Newman delineated that not all services were available
for every waiver; some only provided one service, some
provided many services, some only applied to group living
homes, and some were only for in-home care. All waivers
relied on care coordinators who set up a plan and helped
waiver recipients take advantage of resources in their
community. He detailed that care coordinators were not
state employees. They were community members who worked for
private agencies throughout the state.
1:40:08 PM
Mr. Newman moved to slide 4 titled Options for 24/7
Residential Care for People on Medicaid Home and Community
Based Waivers. He expounded that HB 58 provided elderly
Alaskans and adults with disabilities who were enrolled in
Medicaid home and community-based waiver services with a
new living option: Adult Home Care. The bill established a
new licensed residential setting type: Adult Care Home. The
vision was that the service and setting would offer reduced
administrative burdens compared with current assisted
living options but still ensure the care and safety of the
resident. The legislation would help address the shortage
of services and settings for seniors and other individuals
who required help with the activities of daily living and
other assistance to live more independently and created an
option that may enable some people to remain in a
community. He exemplified a provider as someone who could
provide space like an extra bedroom but was unable to
provide all of the care. The idea for the bill had first
been brought to the governor's attention by constituents
who were serving as foster parents for children with severe
disabilities that were aging out of the foster care system
and the only way to continue to provide care was to turn
the home into an assisted living home, which had many
requirements. The department realized that a new type of
home care setting could be of value to other individuals
with disabilities including senior citizens. He pointed to
the proposed Adult Care Home information box on the right
lower corner of the slide and informed the committee that
there would be different administrative expectations
compared to assisted living homes. He indicated that the
reduced requirements would be worked out in regulation as
well as many other aspects like the type of credentials
caregivers would need, the rate of payment, etc. The
division would invite much input from its partners that
included care coordinators, families, service providers,
advocacy groups, etc. and from the Center for Medicaid and
Medicare Services (CMS). The drafted regulations would be
subject to a public comment period.
Mr. Newman concluded that the bill provided a conceptual
framework to implement the new waiver. The bill was
necessary due to the lack of care options, growth in the
senior population, and workforce shortages. The situation
required that the department think creatively and provide
more options to help people get necessary care while living
as independently as possible. The concept was especially
important in small communities that lacked good care
options. The department expected that Adult Home Care would
grow in popularity and ultimately be an attractive
alternative for Alaskans.
1:43:07 PM
Mr. Newman concluded the presentation and offered to go
through the sectional analysis.
Co-Chair Foster requested a review of the sectional.
Mr. Newman reviewed the sectional analysis (copy on file):
Section 1. Adds a new section in AS 47.07, Medicaid
Assistance for Needy Persons, declaring that the state
shall pay for adult home care services for an
individual at a daily rate set by the department in
regulation for individuals on Medicaid who are at
least 18; enrolled in a home and community-based
waiver under AS 47.07.045; if the individual's support
plan is approved for adult home care services; and if
they person providing the services to the individual
holds an adult care home license issued under AS
47.32. This section also allows individuals to receive
habilitative and rehabilitative care in addition to
adult home care services and directs the department to
adopt regulations setting a rate for the service,
establish standards for operating an adult care home,
and establish a procedure for transitioning an
individual from a licensed foster care home to a
licensed adult care home. This section also directs
the department to establish a simple and efficient
process to allow a foster parent who holds a foster
home license issued under AS 47.32 to transition from
the foster home license to an adult care home license
for purposes of maintaining the placement of and
services provided to an individual who is
transitioning out of foster care, enrolled in a
waiver, and at least 18 years of age.
Section 2. Amends AS 47.32.010(b) to add a new entity,
"adult care homes," that shall be subject to the
centralized licensing functions of the department.
Section 3. Adds a new section to AS 47.33 that defines
the conditions under which the department may license
an adult care home. A person may be licensed to
operate such a home for an individual who is at least
18 years of age and enrolled in Medicaid and home and
community-based waiver services. An adult care home
may provide 24-hour oversight and care for up to two
adults for compensation or reimbursement under the
adult home care service, allows the department to
establish standards in regulation to authorize care
for up to three individuals based on unusual
circumstances; and defines "care" as providing for the
physical, mental, and social needs of an individual.
Section 4. Amends AS 47.32.900(2) to add adult care
homes to the list of settings that are not defined as
assisted living homes.
Section 5. Amends AS 47.32.900 to add a definition of
adult care home, meaning a licensed home, not a
business site, in which the adult head of household
resides and provides 24-hour care on a continuing
basis for eligible individuals.
Section 6. Amends uncodified law by adding a new
section that requires the Department of Health to
submit for approval by the United States Department of
Health and Human Services an amendment to the state
medical assistance plan, waivers, or an 1115
demonstration waiver as necessary to allow eligible
individuals to receive adult home care services and
other long-term care services that are not
duplicative.
Section 7. Amends uncodified law by adding a new
Conditional Effect Notification section specifying
that Section 1 takes affect if the United States
Department of Health and Human Services approves
amendments to the state plan submitted under Section 6
by July 1, 2027, and adds requires the commissioner of
health to notify the revisor of statutes in writing
within 30 days that those amendments were approved.
Section 8. Provides for an effective date for any
portion of section 1 as the day after the revisor of
statutes receives notice from the commissioner of
health, per Section 7.
1:45:32 PM
Co-Chair Foster referenced the fiscal notes. He stated that
committee members could ask questions about fiscal notes
during the current meeting and receive an answer the
following meeting.
Representative Josephson supported the legislation. He
understood that the current fiscal notes were in
anticipation of implementing the program. He asked once
the program was running what the General Fund (GF) need
would be. He asked if it would be possible to decrement
other programs for services that were no longer necessary
due to the new care type. Mr. Newman answered that the
fiscal notes addressed hiring two new staff. He elaborated
that one would be placed in the Division of Senior and
Disabilities Services (SDS) to administer the adult home
care service by certifying and monitoring providers. The
other staff would be housed in the Division of Health Care
Service for licensing needs. There was not a fiscal note
for Medicaid Services because the Adult Care Home service
would serve as an alternative to the existing service and
in some cases, it would be more expensive and, in some
cases, it would be less expensive. He anticipated that
costs would breakeven and DOH did not anticipate an
increase in Medicaid serve costs.
1:48:11 PM
Representative Stapp looked at both of the positions under
the fiscal notes. He wondered whether all of the backend
work as far as the waiver application process through CMS
was already completed. Mr. Newman answered in the negative
and added that the work had not yet been done. He noted
that the department had a policy team that did the work of
interfacing with CMS when changes to the waivers were made.
Representative Stapp stated that applying for a waiver
typically had an associated cost. He asked if the cost was
already covered and assumed the department could handle it
with existing resources. Mr. Newman responded in the
affirmative.
Representative Galvin assumed that other states had similar
issues and turned to similar programs. She asked if there
was data that could help detail the ongoing costs of the
proposed program. Mr. Newman responded that one of the
challenges with comparing the waiver program with other
states was that every state's waiver program was different.
He delineated that Washington and Oregon had similar
programs in place with different names, but the idea was
similar across the board in other states as well. The
program enabled turning private homes where seniors and
those with disabilities could live and subject them to
lower licensing requirements than assisted living homes.
They would become a less expensive alternative than nursing
homes and other institutional care.
1:50:48 PM
Representative Galvin asked for verification that the
proposal had been proven to be less of an expense than
institutional care. She voiced that it was reassuring to
hear other states had successful programs. She wondered how
long the program had been in effect in other states. Mr.
Newman replied that the programs had been in existence for
years, but he did not know the exact length of time.
Co-Chair Johnson asked how many people the department
expected to be part of the program over time. Mr. Newman
answered there were currently about 5,500 Alaskans on Home
and Community Based Waivers, with approximately 2000
residing in institutional care or assisted living homes. He
elaborated that the program intended to serve a smaller
subset of people. He did not know the number of people that
would eventually sign up. He noted that the fiscal note was
estimated at 40 people occupying the homes in the first few
years. Co-Chair Johnson looked at the fiscal note that
remained the same until FY 2029 when a new position was
added. She asked if the funding would be automatically
added to the base without coming back to the legislature.
1:53:43 PM
Mr. Newman responded that he was not certain how it worked.
He guessed that there was some sort of true up that
informed the legislature of the intended funding for a new
position.
Co-Chair Foster remarked that the next bill hearing would
include authors of the fiscal notes that could answer
questions.
Mr. Newman interjected that someone from the department was
online to answer the question. He indicated that the
question of anticipated need for the program in the
outyears could be answered.
ROBERT NAVE, PROGRAM MANAGER, DIVISION OF HEALTH CARE
SERVICES, DEPARTMENT OF HEALTH (via teleconference),
replied that the forecasted need for the extra position in
FY 29 was based off the current caseload of a Community
Care Licensing Specialist 1, which was 76 assisted living
homes. The anticipated increase in licensing needs created
the need for the secondary position in FY 29.
Co-Chair Johnson was curious about whether the increase in
the outyears would be automatic because it was in the
fiscal note.
Co-Chair Foster indicated that he would reach out to the
Legislative Finance Division for an answer.
Co-Chair Johnson asked where the new positions would
reside.
1:56:23 PM
Mr. Newman believed the positions would be located in
Anchorage.
Representative Coulombe pointed to a bullet point on slide
4 that stated, less administrative requirements. She
acknowledged that the requirements would be forthcoming.
She cited page 1, Section 1 of the bill and noted the
requirements were establishing a daily rate, standards for
care, standards for operating and transitioning, etc. She
understood the concept that there should not be as many
requirements as in assisted living homes, but it appeared
that many requirements could not be eliminated. She was
concerned because it was often family members providing
care and if they had to jump through so many hoops to get a
license it could create a second waiting list. She wondered
if there was a discussion about removing some of the
assisted living requirements from the list.
Mr. Newman answered that the department had compiled some
ideas regarding lowering the administrative burden. He
detailed that currently an assisted living home was
required to maintain three months of operating reserves. He
desired to waive that requirement and reduce other
administrator requirements. He reported that there was a
degree requirement to operate an assisted living home which
he wanted removed or lessened. There was a small licensing
fee to provide assisted living, which the department would
like to see waived. In addition, the DOH wanted to remove
square footage requirements. The department intended to
engage with the stakeholders for input. Representative
Coulombe favored the ideas. She asked about the few bad
actors that may try to take advantage of the program. She
wondered if there had been discussion around follow ups or
how the service would be monitored and inspected to ensure
client safety. Mr. Newman answered that it would be a
certified service and the service would need to be renewed
with the division and licensure renewal included home
visits and monitoring.
2:00:19 PM
Representative Coulombe asked what the ramifications would
be if a person was not taking good care of their residents.
Mr. Newman responded that the individual receiving care
would not lose their waiver. The department would suspend
certification if the provider was not living up to the
standards and requirements and waivers could revoked.
Representative Ortiz asked if the purpose of the bill was
to make homecare more available in Alaska and more
affordable and advantageous for people to consider
providing the services in their homes because the services
would be covered through Medicaid. Mr. Newman confirmed
that Representative Ortizs summary of the bill was
correct. He added that the bill was intended to provide
more home style alternatives so people could stay in their
home or community and also enable more providers to become
available. Representative Ortiz deduced that the provider
would also be motivated by the ability to get some
reimbursement for the service. Mr. Newman answered in the
affirmative. Representative Ortiz asked whether HB 58
enabled more options available in rural areas. He asked if
monitoring in rural areas was possible.
2:03:53 PM
Mr. Newman responded that providing services in rural areas
was exactly the hope, particularly in rural communities
where assisted living was lacking. The driving force of the
legislation was to enable people to remain in their
communities. Representative Ortiz thought the concept
sounded good.
Representative Hannan relayed that she had a family member
in care that passed away and was assessing the bill as it
related to her experience. She referenced the sectional
analysis that stated the head of the household lived in the
residence and provided 24 hour care. She wanted to ensure
that her interpretation was not so narrow as to assume the
person was the only caregiver. She wondered whether other
caregivers were allowed or was it reliant on only the head
of the household as caregiver. She noted that no individual
could provide 24 hour care for very long. Mr. Newman
replied that one of the things he was most looking forward
to with HB 58 was to decide on the ancillary services that
would assist the caregiver. He pointed to Section 1 of the
bill that allowed an individual may receive habilitative
and rehabilitative care in addition to adult home care
services. He delineated that the resident would receive
supplemental services. The details would be worked out with
stakeholders to determine what mix of services would be
available. The homeowner would be expected to provide a
certain level of care and what needed to be determined was
the supplemental care services. Representative Hannan
shared that when her sister needed increased overnight care
and had finally agreed to assisted living, she needed a
nurse to administer medications. She hoped that in the
proposed adult home care model a caregiver could administer
medications, or the person would need to reside in a
nursing home. She added that current assisted living homes
were not set up to administer medications. She presumed the
division was fully aware of the situation.
2:08:22 PM
Mr. Neuman replied that every case was different and
emphasized that every person needed different care and a
different level of care. He noted that one of the waiver
services called nursing oversight where a nurse could be
available to a caregiver.
Co-Chair Foster reiterated that there would be a deeper
dive into the fiscal notes in the next bill hearing.
HB 58 was HEARD and HELD in committee for further
consideration.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 58 LFD Response to Q Out Year FN Costs 041323.pdf |
HFIN 4/12/2023 1:30:00 PM |
HB 58 |