05/08/2025 01:30 PM House FINANCE

HOUSE BILL NO. 73                                                                                                             
                                                                                                                                
     "An Act relating to complex care residential homes;                                                                        
     and providing for an effective date."                                                                                      
                                                                                                                                
2:10:32 PM                                                                                                                    
                                                                                                                                
Co-Chair Foster asked  his staff and the  department to come                                                                    
to the table.                                                                                                                   
                                                                                                                                
Co-Chair  Schrage  MOVED  to ADOPT  the  proposed  committee                                                                    
substitute  (CS)  for  HB 73,  Work  Draft  34-GH1493\N  (A.                                                                    
Radford, 5/8/25) (copy on file).                                                                                                
                                                                                                                                
Co-Chair Foster OBJECTED for discussion.                                                                                        
                                                                                                                                
Co-Chair Foster asked his staff to explain the CS.                                                                              
                                                                                                                                
BRODIE   ANDERSON,   STAFF,  REPRESENTATIVE   NEAL   FOSTER,                                                                    
explained the changes in the CS  located on page 3. He began                                                                    
on   line   10   with  the   language:   "provides   24-hour                                                                    
multidisciplinary care on a  continuing basis to individuals                                                                    
with..." He  explained that the previous  version included a                                                                    
15-bed limit  associated with the  language. The CS  did not                                                                    
include the  15-bed limit. He moved  to page 3, line  19 and                                                                    
explained that  Section 6 of  the bill read "this  act takes                                                                    
effect July 1, 2026." He noted  it reflected a change to the                                                                    
bill's  effective   date.  He  detailed  that   all  of  the                                                                    
conditional language  had been deleted. He  relayed that the                                                                    
Department of Health (DOH) would  explain the reason for the                                                                    
accompanying memo  from Legislative Legal Services  (copy on                                                                    
file) in  regard to the  conditional language  and effective                                                                    
date  and would  explain why  it was  not a  concern to  the                                                                    
department.                                                                                                                     
                                                                                                                                
2:13:25 PM                                                                                                                    
                                                                                                                                
EMILY   RICCI,  DEPUTY   DIRECTOR,  DEPARTMENT   OF  HEALTH,                                                                    
explained that the bill created  a licensure type that could                                                                    
exist independent of any certification  from the Centers for                                                                    
Medicare and  Medicaid Services (CMS).  Section 5 of  the CS                                                                    
provided  DOH  with the  ability  to  apply for  waivers  as                                                                    
necessary to meet  the needs of individuals  in complex care                                                                    
residential  homes. She  expounded that  for CMS  to approve                                                                    
coverage for services  in a home, it required  that the home                                                                    
or   residential  facility   or  unit   be  certified.   The                                                                    
certification  was  separate  from  the  license  type.  She                                                                    
detailed that  in the past,  the department had  put forward                                                                    
bills that include the conditional  language, but it was not                                                                    
necessary for  the actual license  type to take  effect. The                                                                    
department was focused  on getting the service  in place for                                                                    
populations  in  need.  The   department  believed  a  clean                                                                    
effective date would allow it  to move forward expeditiously                                                                    
and would not  impact the result of the  bill. She explained                                                                    
that  Section 5  still  gave DOH  the  flexibility to  align                                                                    
Medicaid  payments  for  individuals receiving  services  in                                                                    
complex care residential homes.                                                                                                 
                                                                                                                                
Representative Galvin  assumed DOH needed to  go through the                                                                    
process  to  get  the  waiver. She  wondered  if  Ms.  Ricci                                                                    
thought that it may not be necessary.                                                                                           
                                                                                                                                
Ms. Ricci replied  that depending on the  type of individual                                                                    
and the  care they needed, different  funding mechanisms may                                                                    
be available  through the  Medicaid program.  The department                                                                    
may  be  able  to  provide  some  of  the  services  through                                                                    
existing  payment  means  for individuals  in  complex  care                                                                    
residential  homes within  some of  the available  waiver or                                                                    
state   plan  services.   Whereas,   for   other  types   of                                                                    
individuals  (e.g.,  individuals  with dementia  and  severe                                                                    
mental  illness),  the department  may  need  to look  at  a                                                                    
different type of  waiver in order to  have Medicaid support                                                                    
the services. She noted that the  state may be able to amend                                                                    
the existing 1115 waiver for  some populations. She remarked                                                                    
that it  could get a  bit complicated, which was  the reason                                                                    
DOH  wanted   to  ensure  there   was  flexibility   on  the                                                                    
implementation date for the licensure type.                                                                                     
                                                                                                                                
Representative  Galvin  asked  if  DOH  was  working  toward                                                                    
completing the licensure  type by the date  specified in the                                                                    
bill or if DOH would begin  working on the licensure type on                                                                    
the specific date.                                                                                                              
                                                                                                                                
Ms. Ricci  answered that DOH  would be prepared to  have the                                                                    
licensure type ready by the  date specified in the bill. The                                                                    
department would  be working through the  regulatory process                                                                    
to outline what the licensure  type would look like for some                                                                    
of  the populations.  Simultaneously, DOH  would be  working                                                                    
with the Medicaid program to  determine funding streams that                                                                    
would be available for some of the different populations.                                                                       
                                                                                                                                
2:16:52 PM                                                                                                                    
                                                                                                                                
Representative  Bynum observed  that changing  the effective                                                                    
date to July  1, 2026 would mean waiting until  2026 for the                                                                    
bill to  go into effect.  He asked for verification  that it                                                                    
would  give  the department  the  time  to prepare  for  the                                                                    
rollout on July 1.                                                                                                              
                                                                                                                                
Ms.  Ricci  agreed. She  explained  it  was one  reason  the                                                                    
department  wanted   to  remove  some  of   the  conditional                                                                    
language to make  sure it was possible to  move quickly. She                                                                    
elaborated   that  the   department   believed  having   the                                                                    
effective  date in  hand  for the  licensure  type gave  the                                                                    
department the ability to do so.                                                                                                
                                                                                                                                
Representative Bynum asked if the  changes in the bill would                                                                    
result in any changes to the fiscal notes.                                                                                      
                                                                                                                                
Ms. Ricci answered, "No."                                                                                                       
                                                                                                                                
Co-Chair Foster WITHDREW the OBJECTION.                                                                                         
                                                                                                                                
There  being  NO  OBJECTION,   Work  Draft  34-GH1493\N  was                                                                    
ADOPTED.                                                                                                                        
                                                                                                                                
2:18:15 PM                                                                                                                    
                                                                                                                                
Co-Chair  Schrage  MOVED  to  REPORT  CSHB  73(FIN)  out  of                                                                    
committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal notes.                                                                                                      
                                                                                                                                
There being NO OBJECTION, it was so ordered.                                                                                    
                                                                                                                                
CSHB 73(FIN)  was REPORTED  out of  committee with  nine "do                                                                    
pass"     recommendations,    one     "no    recommendation"                                                                    
recommendation, and one "amend"  recommendation and with one                                                                    
new indeterminate fiscal note  from the Department of Family                                                                    
and  Community  Services;  two previously  published  fiscal                                                                    
impact notes:  FN1 (DOH) and  FN2 (DOH); and  one previously                                                                    
published zero note: FN3 (DOH).                                                                                                 
                                                                                                                                
Co-Chair Foster thanked the department.