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,  Senior  and Disability  Services,  explained                                                              
that Home  and Community-Based [Services]  (HCBS) and  the 1915(c)                                                              
Home and  Community-Based 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   Home  and                                                              
Community-Based  Waiver Services.    He expounded  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 in 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  SDS [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  with 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                                                              
perspective of  SDS, 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 SDS.                                                                                                     
                                                                                                                                
MR. LEE  explained that because  SDS 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.]