Legislature(2025 - 2026)BARNES 124
04/16/2025 03:15 PM House LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| HB96 | |
| HB193 | |
| HB144 | |
| HB161 | |
| SB80 | |
| State Nursing Board | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 96 | TELECONFERENCED | |
| += | HB 144 | TELECONFERENCED | |
| *+ | HB 193 | TELECONFERENCED | |
| *+ | HB 161 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED | ||
| += | SB 80 | TELECONFERENCED | |
HB 96-HOME CARE EMPLOYMENT STANDARDS ADV BOARD
4:33:17 PM
CO-CHAIR FIELDS announced that the first order of business would
be HOUSE BILL NO. 96, "An Act establishing the Home Care
Employment Standards Advisory Board; relating to payment for
personal care services; and providing for an effective date."
[Before the committee was CSHB 96(HSS).]
4:33:35 PM
REPRESENTATIVE MIKE PRAX, Alaska State Legislature, as prime
sponsor, presented CSHB 96(HSS). He gave a prepared sponsor
statement [included in the committee file] for CSHB 96(HSS),
which read as follows [original punctuation provided]:
Seniors are the fastest growing demographic in the
state of Alaska and are living longer lives. The
state's 85+ population is expected to increase by 500%
between 2022 and 2050, of which, 1/3 will experience
Alzheimer's and Related Dementia. The Alaska
Department of Labor and Workforce Development predicts
home care, a part of Alaska's continuum of care
services for seniors and people with disabilities, to
be one of the fastest growing and most in demand
occupations in the state.
Alaska faces an acute shortage of direct care workers,
particularly outside of population centers. The
potential provider workforce demographic, those age 18
to 64, is in decline. Furthermore, low pay and lack of
benefits force many caregivers out of the profession
and make recruitment and retention increasingly more
difficult for agencies providing in-home care
services.
We need to create strong and long-lasting home care
infrastructure in Alaska which will expand access to
quality, affordable home and community-based care for
seniors and people with disabilities, keep people in
their homes and out of costly facilities, and bolster
the creation of jobs. We also need to ensure that
Medicaid funding for personal care services is wisely
spent, with an adequate portion of the rate going to
pay and benefits for direct care workers, in order to
help address the workforce shortage. HB 96
accomplishes both of these objects by:
• Establishing a Home Care Employment Standards
Advisory Board that will investigate, advise, and
develop recommendations on Medicaid rates and other
policies to improve the wages, working conditions, and
recruitment and retention of direct care workers.
• Requiring that agencies providing personal care
services spend at least 70 percent of the total annual
funding they receive from the department for personal
care services on the pay and benefits of Personal Care
Assistants providing such services.
REPRESENTATIVE PRAX provided a personal anecdote about his
family's experience with home care providers with his aunt and
uncle.
4:37:29 PM
RILEY NYE, Staff, Representative Mike Prax, Alaska State
Legislature, presented the sectional analysis [included in the
committee file] on behalf of Representative Prax, prime sponsor
of CSHB 96(HSS), which read as follows [original punctuation
provided]:
Section 1 amends AS 44.29 by adding new sections to it
and various aspects of the Home Care
Employment Standards Advisory Board. Thus,
Sec. 44.29.900. Home Care Employment Standards
Advisory Board. This section is added to
establish the advisory board on Home Care Employment
Standards in Alaska.
Sec. 44.29.905. Composition of the board. This section
elaborates on the composition of the
board which will consist of a chair, 6 voting, and 4
non-voting members. The section clarifies
how many members should be sought from each
represented group or institution. The members
will be appointed by the Commissioner of Health after
solicitation of applications. Thus,
• Commissioner of Health or commissioner's designee
(non-voting unless in the event of a
tie)
• Commissioner of Labor and workforce development (or
the commissioner's designee)
(non-voting)
• Two members representing covered providers, (with
variance in terms of size, services
provided and geographical location) (voting)
• Two members who represent direct care workers
(voting)
• One member who is an enrollee or representative of
enrollees receiving covered services
(voting)
• One member who represents the office of rate receive
(voting)
• A representative of the Alaska Commission on Aging
or another organization that
represents seniors in the state (non-voting)
• A representative of the Governor's Council on
Disabilities and Special Education another
organization that represents people with disabilities
in the state (non-voting)
Sec. 44.29.910. Term of office, vacancies, removal.
This section explains how the members of
the board appointed in AS 44.29.905(3) will serve and
establishes how long they shall serve,
options for reappointment and how vacancies will be
filled.
Sec. 44.29.915. Meetings. The section establishes the
duty of the chair to call for meetings of the
board with regularity and as needed. It also
establishes that the board should meet at least three
times each year and hold additional meetings as often
as necessary to accomplish its duties. At
every meeting, the Board will provide space for public
testimony.
Sec. 44.29.920. Quorum. The section clarifies that a
majority of the members of the Board
constitute a quorum in a meeting of the board for it
to transact its official business and to approve
any recommendations of the Board.
Sec. 44.29.925. Compensation. This section refers to
established rules under AS 39.20.180 to
guide compensation of members of the board through per
diem and expenses reimbursement.
Other than that, members of the Board will not receive
compensation.
Sec. 44.29.930. Powers and duties. This section
establishes the duties and powers of the board
which include advising and consulting the department
on medical assistance program payment
rates for covered services and payment rate adequacy
for covered services, as well as
investigating employment issues and concerns including
wages, working conditions and
workforce development and making recommendations. This
section also describes state
compliance with information requests and testimony,
and ensures the board will have access to
data needed to fulfill its responsibilities.
Sec. 44.29.935 Biennial report. The section requires
the board to submit a written report
biennially to the Commissioner. It also requires the
department to take the recommendations of
the board into consideration when setting rates for
covered services. If the department sets a rate
that differs significantly from the recommendation of
the board, the commissioner shall provide
written notification to the board and chair of each
legislative committee having jurisdiction over
Health and Social Services.
Sec. 44.29.940. Publication of reports. This section
mandates the publication of the reports on
July 1 each year and the reports must be publicly
accessible. The section also elaborates on what
shall be included in the published reports.
Sec. 44.29.945. Definitions. This section specifies
the definitions of all the terms used in the
sections above i.e. AS 44.29.900 - 44.29.945 including
those that relate to Section 1915(c) of the
Social Security Act (42 U.S.C. § 1396n(c))
Section 2 amends AS 47.07.045 by adding new
subsections that require an agency providing
personal care services to pay as compensation and
benefits to employees providing personal care
services at least 70 percent of total annual funding
received by the agency for the purposes of
providing personal care services, increasing to 80
percent by July 1, 2030, unless the agency
receives a hardship exemption from the department.
This section also requires the department to
establish procedures and objective criteria for
granting a hardship exemption, and sets alternative
minimum requirements for an agency that qualifies for
such an exemption.
Section 3 amends the uncodified law of the State of
Alaska by adding a new section establishing
when the board should be appointed, that the first
meeting should be held on or before October 1,
2025, and the issues to be investigated for the
preliminary report which will be presented at the
first meeting.
Section 4 amends the uncodified law of the State of
Alaska by adding a new section establishing
the date for preliminary internet website publication
of the publication to be no later than July 1,
2026.
Section 5 amends the uncodified law of the State of
Alaska by adding a new section instructing
the Department of Health to amend the state plan under
AS 47.07.045 and submit for approval to
the United States Department of Health and Human
Services, to the extent necessary.
Section 6 amends the uncodified law of the State of
Alaska by adding a new section that makes
this Act conditional on the United States Department
of Health and Human Services approving
amendments submitted in accordance with section 5, or
determines that approval is not
necessary.
Section 7 sets the day after the date on which the
United States Department of Health and
Human Services approves amendments to the state plan
or determines that approval is not
necessary under section 6 of this act, as the date
section 2 of this Act takes effect.
Section 8 sets July 1, 2025 as the date the Act takes
effect, except as provided in section 7.
4:44:45 PM
CO-CHAIR FIELDS suggested that increased support for home care
would decrease the cost to Alaska with regards to nursing home
care.
REPRESENTATIVE PRAX responded that home care services are
typically cheaper than care in nursing facilities or hospitals.
4:46:00 PM
JUDY JESSEN, Senior Political & Advocacy Organizer, The
Caregivers' Union SEIU 775, began her invited testimony by
stating that SEIU 775 represents more than 55,000 direct care
workers in Alaska, Montana, and Washington. She reported that
Alaska is experiencing a demographic shift, noting that Alaska
has had the fastest-growing senior population per capita in the
country in the past decade. She further noted that this trend
is expected to continue into the next decade and will create
increased demand for care. She reported that older residents in
Alaska and residents with disabilities are living longer lives,
noting that needs become more complex with age. She also noted
that Alzheimer's and elders dementia is "on the rise." She
cited the Department of Labor & Workforce Development (DOLWD),
predicting that "in-home care will be one of the fastest growing
and in-demand occupations in the state." She further reported
that the number of potential caregivers is in decline and
stressed that the shortage was "even more stark" in rural and
remote Alaska. She stated that the highest concentration of
seniors lives in Southeast Alaska and the Peninsula.
MS. JESSEN emphasized that institutional care and congregate
care settings could cost the state hundreds of thousands of
dollars per person per year. She cited a Department of Health
(DOH) study, reporting that care provided in-house can cost 59
percent less than services received through intermediate care
facilities for individuals with intellectual disabilities. She
additionally reported that in-home care services can cost
between 45- to 90-percent less that nursing home care for
seniors and people with disabilities. She cautioned that the
problem would only become more costly for Alaska without
immediate change to support a strong, well-trained professional
direct care workforce in Alaska.
MS. JESSEN asserted that CSHB 96(HSS) would ensure that the
state is maximizing the state's Medicaid personal care rate by
creating a labor rate for personal care services which, she
explained, was a percent of the Medicaid rate received by
agencies for personal care assistant (PCA) services which is
required to go into direct pay and benefits for direct care
workers. She stated that Alaska's personal care services were
provided through a non-traditional consumer-directed agency with
choice model, meaning that less money was needed for overhead,
as the agency held fewer responsibilities. She stated that the
consumer, not the agency, was responsible for recruitment,
hiring, training, et cetera. Additionally, she asserted that
CSHB 96(HSS) would create transparency with regards to the
distribution of the Medicaid personal care rate. She stated
that the reporting requirements under CSHB 96(HSS) would help
assess and change the efficacy of current personal care rates.
She stated that the workforce standards advisory board, modelled
after Delaware and created under CSHB 96(HSS) would help
identify and plan long-term workforce needs and additionally
assess whether the [personal care] rates are adequately meeting
those needs. She stated that the proposed board, made up of
various stakeholders, would identify priorities, recommend
solutions, and assess resource needs for the caregiving
industry. She said that demographic changes are underway, and
caregiver shortages are deeply felt in Alaska. She concluded
by asserting that CSHB 96(HSS) would be far less costly for
Alaska in the long-term and provide Alaska residents with much-
needed care. She thanked the committee.
4:53:10 PM
REPRESENTATIVE COULOMBE asked whether there was a set hourly
rate for PCAs.
MS. JESSEN responded that "there are different service
categories for which there are different rates." She explained
that the hourly rate is set by DOH. She noted that the personal
care services rate is one of the lower rates in Alaska. She
further explained that CSHB 96(HSS) would allocate 70 percent of
the personal care services rate, not 70 percent of the money
received by agencies overall.
4:54:48 PM
TONY NEWMAN, Deputy Director, Division of Senior & Disabilities
Services, Department of Health (DOH), answered questions during
the hearing on CSHB 96(HSS). He clarified that DOH establishes
rates for personal care and pays $8.53 per 15-minute increment
for PCAs.
4:55:35 PM
REPRESENTATIVE SADDLER stated that the proposed advisory board
in CSHB 96(HSS) appears to have a lot of authority and power,
citing the powers and duties listed in the proposed legislation.
He asked whether DOH was functioning adequately.
REPRESENTATIVE PRAX deferred to Mr. Newman.
MR. NEWMAN responded that the Center for Medicare and Medicaid
Services (CMS) created a rule in 2024 called the Medicaid
Ensuring Access Rule ("Access rule"), which requires the
establishment of an "interested parties advisory group." He
noted that the Access rule requires by law a variety of things
to be implemented by the state over the next 8 to 10 years. He
explained that the advisory board established under CSHB 96(HSS)
would serve as the "interested parties advisory group" whose
function was to assess rates of payment for personal care and
other services. He said that Alaska was federally required by
2028 or 2030 to set an adequacy rule of 80 percent, meaning that
80 percent of Medicaid rate paid for personal care services
would need to be given to the direct care worker.
CO-CHAIR FIELDS stated that in 2020 or 2021, the legislature
heard that there was a crisis in workforce availability,
especially in homecare. He noted that a shift to nursing home
care would be significantly more expensive for Alaska. He
reported that Alaska attempted to ensure that there was adequate
workforce availability for homecare and that it became unclear
whether the workforce was being adequately paid. He asserted
that CSHB 96(HSS) was necessary to collect data on pay.
REPRESENTATIVE SADDLER asked whether the powers and tools of the
proposed advisory board were necessary to fulfill the requests
of CMS. He referred to the proposed board as "nuclear-powered."
4:59:21 PM
REPRESENTATIVE COULOMBE thanked Representative Prax for CSHB
96(HSS), noting that she had heard through public testimony in
prior years that caregivers were overworked and underpaid, and
that there was little oversight.
CO-CHAIR FIELDS offered his agreement with Representative
Coulombe, opining that CSHB 96(HSS) was very important in both
providing adequate care and containing long-term Medicaid
spending.
[CSHB 96(HSS) was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| Marianne Murray Nursing Resume_Redacted 4.16.2025.pdf |
HL&C 4/16/2025 3:15:00 PM |
|
| Cheryl Payne Nursing Resume_Redacted 4.16.2025.pdf |
HL&C 4/16/2025 3:15:00 PM |
|
| HB 193 Sponsor Statement 4.16.2025.pdf |
HL&C 4/16/2025 3:15:00 PM HL&C 4/23/2025 9:00:00 AM |
HB 193 |
| HB 193 Ver G Sectional Analysis 4.10.2025.pdf |
HL&C 4/16/2025 3:15:00 PM HL&C 4/23/2025 9:00:00 AM |
HB 193 |
| HB 193-Paid Parental Leave HL&C PPT 4.16.2025 UPDATED.pdf |
HL&C 4/16/2025 3:15:00 PM HL&C 4/23/2025 9:00:00 AM |
HB 193 |
| HB 96 Version I.pdf |
HL&C 4/14/2025 3:15:00 PM HL&C 4/16/2025 3:15:00 PM HL&C 4/23/2025 9:00:00 AM |
HB 96 |
| HB 96 Sectional Analysis ver I.pdf |
HL&C 4/14/2025 3:15:00 PM HL&C 4/16/2025 3:15:00 PM HL&C 4/23/2025 9:00:00 AM |
HB 96 |
| HB 96 Supporting Document-Cost of Home, Community Based, and Institutional Care 4.10.2025.pdf |
HL&C 4/14/2025 3:15:00 PM HL&C 4/16/2025 3:15:00 PM |
HB 96 |
| HB 96 Supporting Document-Background and Policy Overview 4.10.2025.pdf |
HL&C 4/14/2025 3:15:00 PM HL&C 4/16/2025 3:15:00 PM |
HB 96 |
| HB 96 Supoprting Document-DoH Continuum of Care 4.10.2025.pdf |
HL&C 4/14/2025 3:15:00 PM HL&C 4/16/2025 3:15:00 PM HL&C 4/23/2025 9:00:00 AM |
HB 96 |
| HB 96 Sponsor Statement.pdf |
HL&C 4/14/2025 3:15:00 PM HL&C 4/16/2025 3:15:00 PM |
HB 96 |
| CSHB 144 Supporting Document-PPT Ver N 4.9.2025.pdf |
HL&C 4/14/2025 3:15:00 PM HL&C 4/16/2025 3:15:00 PM |
HB 144 |
| CSHB 144 Ver N 4.9.25.pdf |
HL&C 4/14/2025 3:15:00 PM HL&C 4/16/2025 3:15:00 PM |
HB 144 |
| HB 144 Summary of Changes Ver A to Ver N 4.9.2025.pdf |
HL&C 4/14/2025 3:15:00 PM HL&C 4/16/2025 3:15:00 PM HL&C 4/23/2025 9:00:00 AM |
HB 144 |
| HB 144 Sectional Summary 4.9.2025.pdf |
HL&C 4/14/2025 3:15:00 PM HL&C 4/16/2025 3:15:00 PM HL&C 4/23/2025 9:00:00 AM |
HB 144 |
| HB 161 Legislative Legal Memorandom-2.19.2025.pdf |
HL&C 4/14/2025 3:15:00 PM HL&C 4/16/2025 3:15:00 PM |
HB 161 |
| HB 161 Sectional Analysis Ver G 4.3.2025.pdf |
HL&C 4/14/2025 3:15:00 PM HL&C 4/16/2025 3:15:00 PM |
HB 161 |
| HB 161 PPT 4.13.2025.pdf |
HL&C 4/14/2025 3:15:00 PM HL&C 4/16/2025 3:15:00 PM |
HB 161 |
| HB 161 Sponsor Statement Ver G 4.3.2025.pdf |
HL&C 4/14/2025 3:15:00 PM HL&C 4/16/2025 3:15:00 PM |
HB 161 |
| 2025.04.09 ANTHC LOS HB144.pdf |
HL&C 4/16/2025 3:15:00 PM |
HB 144 |
| Alaska Chamber HB144 Support Letter HLC 4.14.2025.pdf |
HL&C 4/16/2025 3:15:00 PM |
HB 144 |
| ASMA Prior Auth ltr support HB 144 H LC.pdf |
HL&C 4/16/2025 3:15:00 PM |
HB 144 |
| DOG_ASCO_HB 144_Prior Auhtorization_Support.pdf |
HL&C 4/16/2025 3:15:00 PM |
HB 144 |
| HB 161 Letters of Support and Opposition - 4.16.25.pdf |
HL&C 4/16/2025 3:15:00 PM HL&C 4/28/2025 3:15:00 PM |
HB 161 |