Legislature(2023 - 2024)DAVIS 106
02/07/2023 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB17 | |
| HB58 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 17 | TELECONFERENCED | |
| *+ | HB 58 | TELECONFERENCED | |
HB 58-ADULT HOME CARE; MED ASSISTANCE
3:36:40 PM
CHAIR PRAX announced that the final order of business would be
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."
3:37:27 PM
TONY NEWMAN, Acting Director, Division of Senior and Disability
Services, Department of Health, presented HB 58 on behalf of the
sponsor, House Rules by request of the governor. He began a
PowerPoint [hard copy included in the committee packet] and
directed attention to slide 2, "Senior and Disabilities Services
- Medicaid Home and Community Based Waivers," which read as
follows [original punctuation provided]:
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:
• Intellectual and Developmental Disabilities waiver
(serving about 2,000 people)
• Alaskans Living Independently waiver (2,200
people)
• Children with Complex Medical Conditions waiver
(225 people)
• Adults with Physical & Developmental Disabilities
waiver (144 people)
• Individualized Supports waiver (500 people)
MR. NEWMAN gave an example of someone who might be on the
Alaskans Living Independently waiver as a senior who had a
stroke, has limited use of their arms and legs, and has had to
move into an assisted living home. An example of someone on the
Intellectual and Developmental Disabilities waiver might be
someone with cerebral palsy or Down's Syndrome, but with enough
support is able to stay at home or in a group home. He said the
waiver provides people not only with more independence and
personal choice but also saves the state significant amounts of
money that would otherwise be spent on more expensive
institutional care.
MR. NEWMAN moved on to slide 3, "Services available under
Alaska's Medicaid Home and Community-Based Waivers," which lists
the services, as follows [original punctuation provided]:
• Residential Habilitation (Group Home, Family Home
Habilitation)
• In-Home Supports
• Supported Living
• Day Habilitation
• Adult 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 explained that not all the services are available to
every waiver. The one thing all people on waivers have in
common is that they rely on caregiver coordinators to set up
support plans and help recipients take the best advantage of the
resources in their communities. He expressed gratitude for all
those serving as care coordinators. He said they are not state
employes; they work for non-profit organizations or are self-
employed. He said HB 58 seeks to provide people on waivers with
a new service option called, "Adult Home Care," which would be
offered in a new residential setting an "Adult Care Home." He
said the vision is that both the service and setting will have
reduced administrative burdens compared with the assisted living
home option, while still ensuring the care and safety of the
individuals residing in them.
MR. NEWMAN said the idea for HB 58 was brought to the governor's
attention by constituents who were serving as foster parents for
children with severe disabilities who were "aging out" of the
foster care system, and there were no easy ways to continue to
offer care to these foster children as they became adults. The
only option available to them was to turn their home into an
assisted living home, with all the licensure and other
requirements that would entail. He said HB 58 would extend the
possibility of home care to other individuals with disabilities,
including seniors who qualify under the Medicaid Home and
Community Based Waiver program.
MR. NEWMAN covered slide 4, "Options for 24/7 residential care
for people on Medicaid home & community-based waivers," which
compares the assisted living home with the proposed adult care
home. The assisted living home is available for three waivers,
and the adult care home would be available for four waivers. He
said regulations would need to be worked out to cover the types
of training needed, the space expectations, and rates of
payment. He said the division would invite input from its
partners and those with disabilities. The proposed legislation
provides the conceptual framework to get all that started, he
advised. The bill is needed because of the lack of care
options, the growth of the senior population, and workforce
shortages. He stated, "We are hopeful that adult home care will
grow in popularity and ultimately be an attractive alternative,
helping make Alaska the best place it can be for neighbors and
friends to live and grow older together."
3:43:59 PM
MR. NEWMAN presented the sectional analysis for HB 58, which
read as follows [original punctuation provided]:
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. SECTIONAL ANALYSIS
House Bill 58: Adult Home Care Services Prepared on
February 1, 2023 Page 2 of 2
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.
3:47:29 PM
REPRESENTATIVE SUMNER offered his understanding that Medicaid
expansion is 90 percent federal and 10 percent state, and he
asked whether, under HB 58, people eligible for Medicaid
expansion would be declassified, thus increasing the amount of
state matching funds required.
MR. NEWMAN responded that the services provided under the Home
Community Based Waiver are provided at a 50/50 rate. He added
that the individuals who are eligible for the division's
services must be Medicaid eligible.
3:48:28 PM
REPRESENTATIVE SADDLER asked if the provisions under HB 58 would
be "implementing a federally authorized level of service."
MR. NEWMAN replied that Alaska would be developing this service
in collaboration with the Centers for Medicare and Medicaid
Services. He said other states offer similar services, but with
variations that make it difficult to compare state to state.
Unique to Alaska is that all of its services currently offered
not in a home setting require licensure in an assisted living
home setting. In response to another question, he said there
are approximately 50 children on a home and community based
waiver who are also in foster care; five or fewer a year are
graduations from foster care into adulthood and remaining on the
waiver. There are approximately 2,200 seniors on the Alaska
Living Independently waiver.
3:50:59 PM
REPRESENTATIVE FIELDS asked for information as to the funding.
MR. NEWMAN responded that the fiscal note includes staff to
oversee residential licensing. He added that the division
certifies the service, and both the Division of Health Care
Services and the Division of Senior and Disability Services do
the monitoring.
REPRESENTATIVE FIELDS asked about frequency of visits.
MR. NEWMAN deferred the question to Mr. Robert Nave.
3:52:36 PM
ROBERT "BOBBY" NAVE, Assisted Living Home Manager, Division of
Healthcare Services, Department of Health, answered that the
division visits the assisted living homes biannually to inspect
them for the purpose of licensing. Additionally, it conducts
unannounced investigations.
3:53:14 PM
REPRESENTATIVE SADDLER asked a question about two foster
children in a home, where one is aging out but wants to stay in
the home, and whether the home could operate under two
licensures: adult care and foster care.
MR. NEWMAN said that is a situation that arises now, and he
deferred to Mr. Nave to describe how that is handled.
3:54:05 PM
MR. NAVE confirmed that currently the division has dually
licensed homes, and the division coordinates with the Office of
Children's Services to make plans that meet regulations and care
for the clients.
3:54:53 PM
MR. NEWMAN, at the invitation of Chair Prax, reviewed the two
fiscal notes to HB 58 [included in the committee packet].
Referring to fiscal note 1, with the Division of Health Care
Services appropriation, he paraphrased a part of the analysis
section, which read as follows:
One full-time Community Care Licensing Specialist 1
(including benefits): Range 16, Anchorage: $105.0 in
FY2024 and beginning in FY2029 and beyond two
Community Care Licensing Specialists will be needed at
a cost of $210.0 annually. Travel: $10.0 annually for
each position to license and recertify providers.
Years one through five $10.0 annually and year six
$20.0 annually.
Services: Office space, phone, reimbursable service
agreements for position support: $10.0 annually for
each position. Years one through five $14.0 annually
and year six $28.0 annually.
Commodities: Office Supplies $1.0 annually for each
position. Years one through five $1.0 annually and
year six $2.0 annually.
One-Time Commodities Cost: Computer, software, and
office equipment: $3.0 in the first year and $3.0 in
year six with the addition of one more position.
MR. NEWMAN then referred to fiscal note 2, with the Division of
Senior and Disabilities Services appropriation, and he
paraphrased a portion of the analysis, which read as follows:
The division's provider certification and compliance
unit would require one additional permanent full-time
Health Program Manager 2, Range 19, in Anchorage, to
manage the work of certifying and monitoring these
providers for compliance with service rules and
requirements.
Cost for a Health Program Manager 2, Range 19, would
be $119.1 with a 50% Federal/50% General Fund Match.
Annual position costs include: Travel: $2.3; Services:
$14.0; Commodities: $3.0. This position would be hired
to begin July 1, 2024.
Regulations would be needed to define the expectations
for qualifications and service delivery for these
providers.
3:56:23 PM
REPRESENTATIVE MINA prefaced her question by sharing she grew up
in assisted living homes; her family ran assisted living homes.
She pointed to fiscal note 1 and offered her understanding that
it indicates there would be 40 new providers licensed in the
first two years, and she asked where that number is derived.
MR. NEWMAN proffered it is "a fair best estimate," and then he
deferred to Mr. Nave.
3:58:08 PM
MR. NAVE responded that this was a "best estimate" based on
applications and percentages. In response to a follow-up
question, he touched upon the average caseload per provider.
4:00:10 PM
REPRESENTATIVE FIELDS asked how HB 58 would provide for a
situation in which a live-in care giver gets sick and must hire
a caregiver that is not live-in.
MR. NEWMAN answered that those are details that would be "ironed
out" through regulation.
4:01:19 PM
REPRESENTATIVE SADDLER asked if there is any risk that if HB 58
passed, consequently there would be a change in funding.
MR. NEWMAN emphasized the good report and communication the
division has had with the Centers for Medicaid and Medicare
Service. He added, "We've not had them change course that
dramatically in any way, (indisc.)."
4:02:21 PM
REPRESENTATIVE RUFFRIDGE offered his understanding of how HB 58
would work, with a scenario of a family offering foster care and
a child aging out, at which point the parents apply to have
their home licensed as an adult care home and receive some kind
of monthly financial support. He asked, "Is that what that $408
is that's mentioned in the summary of HB 58?"
MR. NEWMAN answered that it is the cost to the state and would
be inclusive of the daily rate, as well as other services for
which the person would be eligible. He added that the daily
rates are figured by the Office of Rate Review.
4:04:50 PM
REPRESENTATIVE MINA, regarding the fiscal notes, asked whether
there may be a need for increased capacity to do inspections if
there is an increase in providers.
MR. NEWMAN responded yes. He said the folks at the Residential
Licensing Section are "more actively out and visiting
facilities." He noted, "Our fiscal note is lower, because we
don't anticipate needing a second person in the out years."
4:06:08 PM
REPRESENTATIVE FIELDS expressed concern that wages that at least
meet minimum state wage requirements would be considered when
considering outsourcing.
4:07:13 PM
CHAIR PRAX announced that HB 58 was held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 17 Support Document - Public Costs From Unintended Pregnancies February 2015.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 Support Document - Unintended Pregnancies Study March 2011.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 Support Document - UCSF Study Newspaper Article 2.22.2011.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 Support Document - HRSA Women's Preventive Services Guidelines.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 Support Document - Insurance Coverage of Contraceptives 4.01.2021.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 Support Document - Guttmacher Alaska Statistics 2016.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 v. A Sponsor Statement.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB17 Version A.PDF |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 58 Sponsor Statement.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 3/7/2023 3:00:00 PM |
HB 58 |
| HB 58 Summary Version A.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 3/7/2023 3:00:00 PM |
HB 58 |
| HB 58 Version A.PDF |
HHSS 2/7/2023 3:00:00 PM HHSS 3/7/2023 3:00:00 PM |
HB 58 |
| HB 58 Sectional Analysis Version A.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 3/7/2023 3:00:00 PM |
HB 58 |
| HB 17 v. A Sectional Analysis.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 58 Presentation.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 3/7/2023 3:00:00 PM |
HB 58 |
| HB 17 Support Letter.docx |
HHSS 2/7/2023 3:00:00 PM |
HB 17 |
| Support letter for HB 58 Redacted.docx |
HHSS 2/7/2023 3:00:00 PM HHSS 3/7/2023 3:00:00 PM |
HB 58 |
| Opposition Letter for HB 17 Redacted.docx |
HHSS 2/7/2023 3:00:00 PM |
HB 17 |
| HB 58 Support Letter 2 Redacted.docx |
HHSS 2/7/2023 3:00:00 PM HHSS 3/7/2023 3:00:00 PM |
HB 58 |