03/18/2021 03:00 PM House STATE AFFAIRS

              HB 103-ASSISTED LIVING HOMES: HOUSE RULES                                                                     
                                                                                                                                
3:41:52 PM                                                                                                                    
                                                                                                                                
CHAIR  KREISS-TOMKINS   announced  that  the  final  order of  business                                                         
would  be HOUSE  BILL  NO. 103,  "An Act  relating  to house  rules  for                                                        
assisted living homes."                                                                                                         
                                                                                                                                
3:42:09 PM                                                                                                                    
                                                                                                                                
JOHN  LEE,  Director,  Division  of  Senior  and  Disability  Services,                                                         
Department  of  Health  and  Social  Services  (DHSS),  explained   that                                                        
home  and  community-based   services   (HCBS)  1915(c)  waivers  exist                                                         
to  provide   significantly   lower  cost   home  and  community-based                                                          
options   for   individuals    who   qualify   for   nursing   home   or                                                        
institutional   care.    He stated   that HB  103  would  bring  Alaska                                                         
law  into  compliance  with  the  HCBS  Final  Rule,  which  was issued                                                         
by  the  Centers   of  Medicare  and  Medicaid   Services   (CMS).    He                                                        
related  that  currently,   Alaska   statutes  are  not  in  compliance                                                         
with  federal   regulation   that  requires   HCBS  providers  to  give                                                         
individuals  on  waivers  the same  access  "to community   and people"                                                         
as  those  who  are  not  on waivers.    He  indicated   that  the  bill                                                        
adds  a citation  to state  statutes  related  to  setting  house rules                                                         
in  assisted  living  homes;  for  example,  assisted  living  settings                                                         
may  not  adopt  house  rules  that  unreasonably  restrict   the right                                                         
of  one  resident  over  the  right  of another   resident.    He noted                                                         
that  Alaska  statutes  must  be in  compliance  before  March  2023  in                                                        
order  for the  state  to continue  receiving  federal  reimbursements                                                          
for  the HCBS  waiver.    He expounded   that  the bill  would  address                                                         
the  federal  requirements   by  inserting   language  into  AS  47.33,                                                         
which  would  bring Alaska  into  compliance  with  recent  CMS changes                                                         
related  to HCBS.   These  requirements   ensure  that assisted  living                                                         
homes  provide   care  that  is  as  close  to  independent   community                                                         
living  as  possible.    He reported   that  Alaska  has  approximately                                                         
700  assisted  living homes  that  would  be required  to abide  by  the                                                        
conditions   defined  under   HB 103.    The  new  statutory   language                                                         
would  afford   all  residents  in  assisted   living  homes  the  same                                                         
rights  regardless   of  whether  or  not  the  home  accepts  Medicaid                                                         
payment.    He noted  that  of  the 700  assisted  living  homes,  more                                                         
than  650   are  already   compliant  through   participation   in   the                                                        
Medicaid waiver program.                                                                                                        
                                                                                                                                
3:48:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   VANCE  questioned  whether  a  legal  notice  would  be                                                        
sent out to notify the homes of the required compliance changes.                                                                
                                                                                                                                
MR.  LEE  reiterated  that  providers   certified  through  Senior   and                                                        
Disability   Services  are  already  in  compliance.    He deferred   to                                                        
Mr.  Baxter  for  further  explanation   of  how additional   providers                                                         
would be notified of the requirements.                                                                                          
                                                                                                                                
3:49:06 PM                                                                                                                    
                                                                                                                                
CRAIG  BAXTER,  Assisted   Living  Home  Manager,  Division   of Health                                                         
Care   Services,   Department    of   Health   and   Social   Services,                                                         
confirmed  that  providers   without  current  house   rules  that meet                                                         
the setting standards would be notified.                                                                                        
                                                                                                                                
REPRESENTATIVE   VANCE asked  how  much time  providers  would  have  to                                                        
come into compliance.                                                                                                           
                                                                                                                                
MR.  BAXTER  approximated   "somewhere   between  30  and  90  days"  to                                                        
update   their  house  rules.     He  speculated   that  DOL  would   be                                                        
consulted  first,  adding  that  he  did not  want  to be  heavy-handed                                                         
in forcing facilities to update in a short period of time.                                                                      
                                                                                                                                
3:50:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   VANCE   referenced   a  supporting  document,   titled                                                         
"HCBS  Settings  Final  Rule:  42  CFR  441.301(c)"  [included   in  the                                                        
committee   packet],  noting   that  the  highlighted   section  states                                                         
that  individuals  are  allowed  to  have visitors   of their  choosing                                                         
at  any  time.    She  asked  whether   that  would  apply  during   the                                                        
COVID-19 pandemic.                                                                                                              
                                                                                                                                
MR.  LEE noted  that  the  change  to statute  is  required  regardless                                                         
of  COVID-19.    He  explained   that  during  the  pandemic,   certain                                                         
regulations,   such as  the one  referenced  by  Representative  Vance,                                                         
were waived.                                                                                                                    
                                                                                                                                
MR.  BAXTER   stated  that  during   the  pandemic,   limitations   were                                                        
placed  on visitation   to protect  the  residents  of the  facilities.                                                         
He  said  the bill  would  affect  facilities   "outside  the  scope  of                                                        
the  COVID-19  pandemic,"   adding  that  once  COVID-19   restrictions                                                         
were   lifted,   the  expectation    for  visitation   would   go   into                                                        
effect.                                                                                                                         
                                                                                                                                
3:51:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE    VANCE   pointed    out   that   state   and   federal                                                         
regulations   [pertaining   to   COVID-19]   are  not   consistent   and                                                        
asked which purview is being followed.                                                                                          
                                                                                                                                
MR.  LEE  said the  flexibility   to manage  the  waiver  programs   are                                                        
contingent   on  the  federal  public   health  emergency.    From   the                                                        
perspective   of the  Division   of Senior   and Disability   Services,                                                         
he said,  the  regulations  are  waived  because of  the public  health                                                         
emergency.                                                                                                                      
                                                                                                                                
3:52:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   CLAMAN  noted  that  the public  health  emergency   is                                                        
no  longer  in  place   unless  the  legislature   takes  action.     He                                                        
asked how that impacts the division.                                                                                            
                                                                                                                                
MR.  LEE   explained   that  because   the   division  flexibility    is                                                        
contingent   on the  federal  public   health  emergency,  the  state's                                                         
decision  whether   to extend   the disaster   declaration  would   have                                                        
no impact on the bill.                                                                                                          
                                                                                                                                
3:53:33 PM                                                                                                                    
                                                                                                                                
CHAIR KREISS-TOMKINS [announced that HB 103 was held over.]