Legislature(2021 - 2022)GRUENBERG 120
04/01/2021 03:00 PM House STATE AFFAIRS
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| Audio | Topic |
|---|---|
| Start | |
| HB118 | |
| HB106 | |
| HB103 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 118 | TELECONFERENCED | |
| += | HB 106 | TELECONFERENCED | |
| += | HB 103 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
HB 103-ASSISTED LIVING HOMES: HOUSE RULES
3:31:13 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."
CHAIR KREISS-TOMKINS questioned whether HB 103 would affect
operations for any subset of assisted living facilities and
whether they would struggle to meet the standards that would be
codified in the bill.
3:33:08 PM
JOHN LEE, Director, Division of Senior and Disability Services,
Department of Health and Social Services, reported that 650 of
the 700 assisted living facilities that are licensed by the
state are currently in compliance. He said he anticipates no
significant challenges from non-compliant providers, as the
required changes are minor.
3:33:53 PM
CRAIG BAXTER, Assisted Living Home Manager, Division of Health
Care Services, Department of Health and Social Services, shared
his belief that the bill would not be burdensome for facilities
that are not in current compliance with the required standards.
He reiterated that approximately 650 of the 705 assisted living
homes are already in compliance because they are state
certified. He said he did not envision the remaining facilities
struggling to implement the changes.
CHAIR KREISS-TOMKINS asked why the remaining 50 facilities would
choose not to be Medicaid certified.
MR. LEE said the majority of providers in Alaska take Medicaid
clients; however, some providers, for various reasons, focus on
private pay or areas outside the provisions of Medicaid.
MR. BAXTER noted that a handful are new providers that have not
yet applied for certification. He surmised that some facilities
choose to care for specific individuals who are private pay so
there's no need for certification. Additionally, other
facilities that meet licensing standards are unable to meet the
standards for certification. He speculated that there is
probably another small subset of [facilities] that had allowed
their certification to lapse.
3:36:29 PM
CHAIR KREISS-TOMKINS referenced page 1, lines 11-12, and asked
for a description of the visitation rights provided under 42
C.F.R.441.301(c)(4)(vi)(D).
MR. LEE relayed that 42 C.F.R states that if a facility chooses
to set house rules, the rules must allow individual choice.
More specifically, individuals must be allowed to have visitors
of their own choosing at any time. Therefore, assisted living
homes may not adopt house rules that restrict those rights.
CHAIR KREISS-TOMKINS asked whether Mr. Lee had observed
facilities in Alaska with unduly restrictive choice or
individual access.
MR. BAXTER said if the Division of Health Care Services became
aware of that, the division would typically follow up with an
investigation to determine the validity of the complaint. If
the division determined the facility was out of compliance, it
would be notified and required to show a plan of correction. he
added that chronic offenders or a particularly egregious offense
may require enforcement action. He shared that when Medicaid
[facilities] implemented these specific visitation requirements,
there were no issues aside for some pushback from facilities
that expressed logistic concerns.
3:39:27 PM
REPRESENTATIVE STORY asked how the quality care of residents is
ensured in the 50 facilities that are not compliant.
MR. BAXTER said [the Division of Health Care Services] conducts
biannual inspections of most assisted living homes. If a
facility is new or had its license reduced to a provisional
license because of enforcement action, an annual inspection is
conducted. He added that some facilities receive more frequent
inspections due to their history of compliance. He reported
that the division receives 8,000-10,000 critical (indisc.)
reports annually, which are reviewed for compliance purposes to
ensure that the facilities are responding appropriately to
events and occurrences within their home. He approximated that
400 of those annual reports are upgraded to ensure that the
facilities receive on-site investigation of compliance.
Additionally, the division maintains routine contact with
providers through a variety of training efforts. Groups that
participate in on-site visits for that purpose typically
communicate any concerns they may have about the facilities,
which initiates follow-up inspections by the division to ensure
compliance when necessary.
3:41:34 PM
REPRESENTATIVE STORY asked whether the department had ever
required the closure of a facility until the necessary changes
were made.
MR. BAXTER affirmed that every year, a handful of homes are
closed by the department through an immediate revocation or
suspension. Occasionally, settlement agreements or correction
plans are entered into to allow the facilities to reopen;
however, if a facility is closing because of its compliance
history, it's typically beyond what the department considers a
safe home for residents to reside in. He added that typically,
it's abuse, neglect, financial exploitation, failure to require
background checks, or failure to provide adequate fire safety.
He explained that the department implements the policy of
progressive enforcement action, so that by the time closure of
the home or non-renewal of the license is required, it's
justified. He reported that only 14 percent of the facilities
statewide have had substantial complaints against them. He
emphasized that the department's preference is for the facility
to first, fix the problem as opposed to shutting its doors. He
said closure is traumatic because it displaces residents and
puts employees out of work; furthermore, in smaller communities,
closing homes is often detrimental because alternative services
are not available.
REPRESENTATIVE STORY inquired about the compliance deadline.
MR. LEE said the federal government's deadline is March of 2023.
3:45:01 PM
The committee took a brief at-ease.
3:46:10 PM
REPRESENTATIVE VANCE asked what kind of guidance is provided to
assisted living homes that are not state-run facilities
regarding [COVID-19] restrictions for residents.
MR. LEE clarified that the bill is not related to the pandemic.
Nonetheless, he noted that during the pandemic, the state
disaster declaration and the federal government allowed the
suspension of certain regulations. He further noted that the
state produced visitation guidelines.
REPRESENTATIVE VANCE asked if the bill were to pass, what would
happen to the assisted living homes that failed to comply with
the required changes.
MR. BAXTER explained that if a facility were out of compliance,
a finding against the facility would be assembled via a report
of inspection or investigation. The home would then be notified
and asked to make the necessary corrections. Additionally,
should the bill pass, the department would require that the
facility update its house rules to reflect the necessary
changes.
REPRESENTATIVE CLAMAN surmised that this matter pertains to the
federal supremacy clause, such that the homes would lose their
Medicaid funding if they failed to comply with the federal
requirements. He said the state could set any rule they want,
but if the federal government implements a rule that limits
visitation, homes would be forced to follow that rule during the
suspension of regulations. He asked if that is correct.
MR. LEE asked Representative Claman to repeat his question.
3:52:07 PM
REPRESENTATIVE CLAMAN asked whether an assisted living home
receiving federal funds is required to follow federal rule.
MR. LEE said Medicaid certified facilities are required to meet
these statutes.
REPRESENTATIVE CLAMAN interjected and clarified that he had
asked about the COVID-19-related suspension of regulations. He
sought verification that homes must follow federal rules during
a suspension because otherwise, they would lose their federal
funding.
MR. LEE replied these rules were suspended during the federal
public health emergency.
REPRESENTATIVE CLAMAN sought confirmation that the federal
government had provided visitation guidelines.
MR. LEE replied in the affirmative.
REPRESENTATIVE CLAMAN sought confirmation that homes receiving
federal funds must follow the visitation guidelines set by the
federal government.
MR. LEE answered yes. He added that the state had issued
guidelines to the facilities on how to operate safely during the
pandemic.
REPRESENTATIVE CLAMAN asked whether the facilities in Alaska are
following direction from the federal government or the state on
how to manage visitation during the public health emergency.
MR. LEE said during the pandemic, the federal government allowed
states to relax their rules; therefore, the facilities were
following state guidelines.
3:54:47 PM
The committee took a brief at-ease.
3:55:16 PM
CHAIR KREISS-TOMKINS opened public testimony. After
ascertaining that no one wished to testify, he closed public
testimony.
3:55:44 PM
REPRESENTATIVE CLAMAN moved to report HB 103 out of committee
with individual recommendations and the accompanying fiscal
notes. Without objection, HB 103 was moved from the House State
Affairs Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 118 Letter of Support - GHS 3.25.21.pdf |
HSTA 4/1/2021 3:00:00 PM |
HB 118 |
| HB 103 Letter of Support - MSHF 3.26.21.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 4/1/2021 3:00:00 PM |
HB 103 |
| HB 103 Letter of Support - AK Regional Hospital 3.26.21.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 4/1/2021 3:00:00 PM |
HB 103 |
| HB 118 Letter of Support - ACLU 3.25.21.pdf |
HSTA 4/1/2021 3:00:00 PM |
HB 118 |
| HB 118 Amendments B.2 and B.3 - 4.1.21.pdf |
HSTA 4/1/2021 3:00:00 PM |
HB 118 |