Legislature(2021 - 2022)DAVIS 106
03/30/2021 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB70 | |
| HB119 | |
| SB70 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 70 | TELECONFERENCED | |
| *+ | HB 119 | TELECONFERENCED | |
HB 119-ADULT FOSTER CARE FOR DISABLED
3:36:10 PM
CO-CHAIR SNYDER announced that the next order of business would
be HOUSE BILL NO. 119, "An Act relating to medical assistance
for recipients of adult foster care services; establishing an
adult foster care home license and procedures; and providing for
the transition of individuals from foster care to adult foster
care homes."
3:37:21 PM
JOHN LEE, Director, Division of Senior and Disabilities
Services, Department of Health and Social Services, introduced
HB 119 on behalf of the sponsor, House Rules, by request of the
governor. He explained that HB 119 addressed an urgent need to
establish safe residential living for certain foster children
who must transition out of foster care upon turning 18 years of
age, by allowing adults to transition their current foster care
license to a new adult foster care home license, in order to
allow a foster child to remain in the same home when the child
is released from state custody.
3:38:13 PM
TONY NEWMAN, Deputy Director, Division of Senior and
Disabilities Services, Department of Health and Social Services,
discussed HB 119 on behalf of the sponsor, House Rules, by
request of the governor. He described the type of individual
the bill was meant to serve, saying this was a person who starts
out life with a disability that could be due to a range of
conditions, such as autism or Down syndrome, or more serious
conditions that can rely on prolonged medical treatment. He
said this could be for anyone assessed with having a disability
such that the individual could receive services in an
institution or skilled nursing facility and is therefore
eligible to participate in an Alaska Home and Community Based
Service (HCBS) Waiver. He said that these children are often in
foster care because their parents were unwilling or unable to
give them the care that they needed and shared that in any given
time in Alaska roughly 20 children are in the state's custody
and have the kinds of disability he was describing. He argued
that these kids could enjoy a secure life in a home setting
instead of an institution.
MR. NEWMAN said the need for HB 119 arises because of changes
that occur when the youth reaches adulthood. He explained that
the foster parent is no longer able to offer traditional foster
care once the youth ages out of state custody. He added that
there are disincentives and obstacles that make it difficult for
a foster parent to transition to a new kind of care giving
arrangement, which in turn makes it hard for the young person to
remain with those people.
MR. NEWMAN said the bill's inception goes back to 2013 when
constituents brought the issue to Governor Mike Dunleavy when he
was a Senator. He shared that in 2017 Governor Dunleavy
introduced Senate Bill 10, which did not pass before he left the
Senate. Mr. Newman said that the governor asked DHSS to return
to work on the issue about one year ago. He explained that the
department has been tasked to find as easy a way as possible for
foster children and foster parents to remain together as a
family if they so choose.
3:41:29 PM
MR. NEWMAN presented a graphic entitled "HB 119 Adult Foster
Care for Disabled." He said the service structure at the
Division of Senior and Disabilities Services is complex, but the
diagram shows what happens currently and how the bill attempts
to provide a solution. He explained the kinds of services and
supports a youth in foster care could receive, including Child
Family Home Habilitation at $157 per day, or a foster care
stipend at about $70 per day, and personal care services, which
he explained is an individual who provides help with the
activities of daily living.
MR. NEWMAN directed attention to the "Adult" portion of the flow
chart. He explained that currently, the Family Home
Habilitation amount is reduced to $126 per day because there are
more waiver services to promote independence, and the aged-out
youths lose personal care services because independence and
self-care is assumed to be occurring. He shared that a parent
would then need to apply for an assisted living home license,
which has considerably higher expectations and requirements than
a foster home license.
3:44:50 PM
MR. NEWMAN summarized the current process saying that when a
foster care child becomes an adult the parents lose the ability
to receive a childcare stipend, the rate of family home
rehabilitation reimbursement is reduced, he/she loses the
ability to receive personal care services, and the foster
parents need to set up the home to meet the license requirements
for an assisted living home.
MR. NEWMAN explained that HB 119 proposes an alternative that
makes it easier for the foster parent and the former foster
child to stay together. Instead of offering adult family
habilitation, the foster parents could be certified as adult
foster parents and receive a daily stipend that has lighter
expectations around providing habilitative services but pays
more than a room and board style rate. He said the department
would create a new Adult Foster Home License, with requirements
more akin to a child foster home than an assisted living home.
He said the best thing would be the continuity of care that HB
119 would allow. He emphasized that no one would be forced into
the new arrangement, but for those who want to stay together
longer, this could be an option.
3:46:54 PM
CO-CHAIR ZULKOSKY asked about different waiver services that are
currently provided to individuals to promote independence.
MR. NEWMAN replied that those services could include
transportation, meals, adult day services, and day habilitation.
CO-CHAIR ZULKOSKY asked if those services would be similar to
those offered through the foster care path that is being
discussed in HB 119.
MR. NEWMAN replied yes. He said that is what the division
envisioned being accessible by the adult who is in adult foster
care.
CO-CHAIR ZULKOSKY asked Mr. Newman to discuss what the personal
care services entail and how the difference in the two types of
stipends would work if the waiver services were similar.
MR. NEWMAN answered that as described earlier, personal care
services are provided by people coming to the homes of
individuals who have limitations in performing the activities of
daily living, such as eating, toileting, bathing, and dressing.
He shared that the division offers personal care services for
individuals after they turn six years old and suggested that it
can be a valuable service as the youth get older.
MR. NEWMAN, in response to the second part of the question
regarding the stipends, he referred to the graphic and said when
a youth is receiving Child Family Home Habilitation, the
caregivers are reimbursed at a rate of $157 a day. He said the
rate goes down to $126 a day when the child becomes an adult
because of the expectation that the caregiver will access the
additional services, and it is assumed that the foster child has
developed some level of independence. He offered that the new
proposed rate was meant to be less than the rate of Adult Family
Home Habilitation, but something more than the expectation of
providing room and board.
3:52:16 PM
CO-CHAIR ZULKOSKY asked for confirmation that there would not be
the mandates or expectations on a foster care environment to
adapt to a home habilitation dynamic, and that is where the
decrease in funding is. She asked if HB 119 expanded options
with an opportunity for adults with disabilities to choose a
foster care option, or if it required a particular path to be
chosen.
MR. NEWMAN those eligible for the service would be youth who had
been in foster care and had been on a Medicaid HCBS Waiver.
CO-CHAIR ZULKOSKY asked for confirmation that HB 119 sought to
add the foster care option without removing the Medicaid home
option if an Alaskan wanted to move into a family home
environment and not the foster care path.
MR. NEWMAN confirmed that the division was preserving all
existing options.
3:54:26 PM
REPRESENTATIVE SPOHNHOLZ clarified that youth can stay in foster
care until the age of 21, and what was being proposed was a new
pathway to adult foster care for those that require long-term
support through disability. She asked for the difference to be
described between a youth foster home license and an adult
foster home license.
MR. NEWMAN responded that the adult foster home license had not
been created yet, but the bill would allow the development of
regulations that would allow DHSS to dive into the details of
what makes an adult foster home different from or similar to a
child foster home. He said the idea is that the adult foster
home would closely resemble the foster home expectation than the
adult assisted living home expectation.
3:57:07 PM
CHRISSY VOGELEY, Community Relations Manager, Office of
Children's Services, Department of Health and Social Services,
answered Representative Spohnholz's question. She echoed Mr.
Newman's statement that the regulations had not been created for
an adult foster home. She explained that DHSS was planning on
looking at the regulations for youth foster homes and carrying
over much of the same expectations. She said that with regards
to environmental safety, the department may look at the assisted
living homes compared with youth foster homes and try to combine
some of the regulations in order to craft what an adult foster
home could look like. She commented that the Office of
Children's Services (OCS) would be looking at changing foster
home regulations for youth shortly and offered that committee
members could look to the new proposed regulations when creating
regulations for HB 119.
REPRESENTATIVE SPOHNHOLZ commented that this sounded like an
opportunity to create a more natural continuum for individuals
in foster care who have experienced a disability and for their
foster parents to continue their relationship into adulthood.
She asked if the vision were that a foster parent could change
his/her license when an individual being fostered transitioned
into adulthood.
MS. VOGELEY yes, that is the intent of the proposed legislation.
She acknowledged that the legislation before the committee did
not go into detail and asked the department to create
regulations to make it a very streamlined process for a foster
parent with a license, who has a foster child, who is medically
complex and wants to remain in the home, to easily transition
into an adult foster care license. She pointed out that while
OCS can retain custody of the youth up to age 21, the intent of
the bill would be that custody could be released at age 18.
REPRESENTATIVE SPOHNHOLZ asked if this could become a permanent
situation for an adult who was in care and was likely to need
additional support for the rest of his/her.
MS. VOGELEY answered yes.
4:00:29 PM
REPRESENTATIVE SPOHNHOLZ asked if DHSS had considered ways to
transition someone in this new adult foster care into a
permanent guardianship or adoption placement that could include
elements of the described supports, so that person could have a
normal family life.
MS. VOGELEY answered that there have been many discussions about
the best ways to coordinate the program. She said the intent
would be expanding the options, specifically for foster youth
with medically complex conditions. She commented that there
could be a number of reasons not to go the foster or
guardianship route with these youth and clarified that this
would be another path that people could opt to do.
REPRESENTATIVE SPOHNHOLZ shared that she had adopted a child
with a cognitive disability. She commented that those with
disabilities may never have independence but may want
permanency. She said it was incumbent upon the committee
members and DHSS to create a natural pathway that doesn't harm
people while creating permanent relationships. She shared that
her daughter has siblings who were never able to get a permanent
relationship because there was concern that they would lose
necessary supports. She said there could have been a permanent
adoption, if it had been clear the foster parents could get the
supports.
4:03:11 PM
REPRESENTATIVE MCCARTY asked if the disabilities to qualify for
such programs had been defined.
MR. NEWMAN answered yes. The expectation is an individual would
be eligible for a HCBS Waiver. He shared that DHSS had been
asked during another committee hearing whether someone who is
hard of hearing would be eligible for this service. He said the
answer was no; the expectation is that to qualify, an individual
has a disability such that they could receive services in an
institution such as an intermediate care facility for
individuals with intellectual and developmental disabilities or
a skilled nursing facility. He concluded it was a "fairly high
degree" of functional disability.
REPRESENTATIVE MCCARTY asked if the disabled adults who were
able to stay on with foster parents would be wards of the court
or of the foster parents.
MR. NEWMAN answered that the guardians of youth are usually
public guardians, often grandparents or family friends. He
explained that the guardianship process would not change from
the way it is done currently.
REPRESENTATIVE MCCARTY described a circumstance where an
individual in adult foster care needed to go into a higher-level
care facility because dynamic in the home changed. He asked
whether that individual could later return to adult foster care.
MR. NEWMAN replied that language in proposed legislation would
allow individuals who had previously been in a foster situation,
but aren't currently, to be able to return. He said it is
estimated that a few former foster children and their families
want to return to those situations.
4:07:11 PM
CO-CHAIR ZULKOSKY asked about the pathway for decision-making
for the youth that are becoming adults and can choose whether to
enter a skilled nursing facility, Medicaid home, or an adult
foster care environment, and how that is articulated under HB
119.
4:08:17 PM
LYNN KEILMAN-CRUZ, Chief of Quality, Division of Senior and
Disability Services, Department of Health and Social Services,
answered questions about HB 119 on behalf of the sponsor, House
Rules, by request of the governor. She said the Division of
Senior and Disability Services works closely with OCS to
identify youth that are "aging out," and works with the families
and the youths to determine if a guardian is needed. She shared
that the division also works with a care coordinator, who in
turn works with the youth to find out his/her goals and living
situation requirements. She offered that this is one way the
division and OCS use to find if an aging out youth needs a
guardian and what the youth's choices are.
CO-CHAIR ZULKOSKY asked if the care coordinator would likely be
involved in the decision-making process with the young Alaskan.
MS. KEILMAN-CRUZ replied not exactly. She explained that the
care coordinator involves a planning team, including, for
example, a family member or grandparent - often whoever is a
part of the youth's natural support system to determine the
needs of the individual. She offered that if the youth needs a
guardian, the team will try to apply for that ahead of time, but
it does not make a decision on behalf of the individual.
CO-CHAIR ZULKOSKY commented that she would be interested in
learning more about the decision-making process that would be
afforded through the proposed legislation outside of the
committee.
MS. KEILMAN-CRUZ stated she would provide the information.
4:11:44 PM
REPRESENTATIVE SPOHNHOLZ asked if it were the intention that if
a youth moved to adult foster care, then the individual's
Medicaid services would seamlessly follow.
MR. NEWMAN answered that that is the expectation.
REPRESENTATIVE SPOHNHOLZ commented that part of having an
"authentic" family relationship is having the adult foster
parents be involved in decision making. She asked how DHSS
anticipated foster parents being included in the decision-making
process. She commented that in her experience as a foster
parent, she wasn't considered in decision making for her youth.
She opined that for a long-term relationship, DHSS may want to
consult with the foster parents.
MR. NEWMAN replied that the intention is for the foster parents
and other individuals who are closely involved in the care to
participate in planning the needed services. He stated that the
division continually tries to put the individual at the center
of the planning process. He said the care coordinator was a
critical piece for bringing people together to identify needed
services and unite efforts.
4:14:10 PM
REPRESENTATIVE PRAX commented that it seemed the caretaker would
have the same relationship as the child became an adult, along
with the same responsibilities and expenses. He asked why they
received less in reimbursement.
MR. NEWMAN explained there are reduced expectations for
providing habilitative services as a child becomes an adult, so
the stipend is reduced. He suggested that the proposed $115 is
an increase from the information from OCS.
REPRESENTATIVE PRAX asked how the legal authority changes
between the foster parent of a child to the foster caregiver of
an adult, and if the caregiver still had authority in the legal
decision-making processes.
MR. NEWMAN replied that the division chose the name of adult
foster care to draw a connection from child foster care, because
it would come with the same "custodial expectations" that
characterize child foster care.
4:18:25 PM
MS. KEILMAN-CRUZ explained that when an individual becomes an
adult at age 18, if the individual is capable of making his/her
own choices, then decisions are not made on the individual's
behalf by the state or by the foster parents. She said if DHSS
determines that the individual lacks the capacity to make the
decisions, there is a "small plethora" of things the individual
can choose, such as power of attorney, a conservator, or a full
guardian. She stressed that it is the individual's choice, and
the individual may choose the foster parent to be the guardian.
She shared that the individual chooses his/her planning
committee.
REPRESENTATIVE PRAX shared that he dealt with an adult in an
unofficial foster care situation that the state didn't approve
of. He said it was undecided if the individual was capable of
making his/her own decisions and a court visitor caused some
complications. He asked if that function came into this
situation as well.
MS. KEILMAN-CRUZ answered, yes. She explained that that is part
of the process for determining if the child or the adult has the
capacity. She said that at that point in time Alaska Adult
Protective Services (APS) may be called upon to help make that
determination. She explained that the court visitor is
appointed by the courts to do the investigation to determine who
would be a good guardian or conservator, or if the young adult
would be better served through power of attorney.
4:21:45 PM
REPRESENTATIVE SPOHNHOLZ offered context, stating that foster
parents do not have guardianship rights for the individuals in
their care. She explained that every foster youth has a
guardian ad litem (GAL), or an adult can have a public guardian.
She said these people are responsible for making legal
decisions. She wanted to clarify earlier comments, saying that
she wanted foster parents included in decisions. She opined
that while foster parents should not have legal rights, because
that is not their role, she thinks they should be involved.
4:23:03 PM
REPRESENTATIVE MCCARTY commented that Representative Spohnholz
was speaking about foster youth who were the wards of the court.
He countered that this discussion was about the foster parents
of adults who needed help. He asked if an adult foster care
person would be a possible candidate as a guardian or a
conservator.
MR. NEWMAN responded that that was discussed in the early stages
of drafting the bill. It was decided that the bill would remain
silent on that point. He offered his understanding that it was
better to avoid conflict of interest.
REPRESENTATIVE MCCARTY offered his understanding that the courts
are still involved, even though the person is not a ward of the
courts.
MR. NEWMAN replied [that that was his understanding]. He
offered that he spoke with the courts about the proposed
legislation, and it was concluded the courts wouldn't change its
process based on the new service.
4:26:05 PM
CO-CHAIR ZULKOSKY commented that she appreciated the discussion
about DHSS's struggle to identify the best verbiage to use. She
said it seemed awkward when talking about youth who were aging
out of foster care, to then refer to an option for them to move
into an adult foster care environment. She said she would be
interested in more accurately capturing what the pathway may be,
such as an in-homecare or family-care environment as opposed to
foster care. She asked if someone could speak to the intention
behind Section 6 of the proposed legislation.
MR. NEWMAN commented that a number of other states have an adult
foster care service. He said DHSS has a consultant who said
this is a common service, and it goes by "Adult Foster Care" in
other states. He acknowledged that it could mean different
things in terms of eligibility and provider qualifications. He
explained that Section 6 has two parts. He said one part is
related to Executive Order (EO) 119, and with the order
withdrawn, the DHSS has no objection to removing that piece. He
said the second part of Section 6 speaks to a "crisis
stabilization center" and a "subacute mental health facility".
He offered that his understanding was that this was conforming
language to make sure that this bill was in alignment with
legislation that is going to be introduced shortly by DHSS and
that the section refers to another Act. He offered his
understanding that the term "subacute mental health facility" is
a better term than a "crisis stabilization center".
CO-CHAIR ZULKOSKY clarified that Section 6, subsection (b) is
conforming language to other proposed legislation that is not
yet introduced.
MR. NEWMAN replied yes.
4:30:03 PM
CO-CHAIR SNYDER commented that during a past hearing in the
House Health and Social Services Standing Committee during
discussion of EO 119, there had been concern about language that
seemed to remove the term "crisis stabilization center", along
with concerns of the implications of that potential action. She
said she was curious if replacing this language for the
forthcoming legislation would cause those concerns to continue.
4:30:52 PM
SUZANNE CUNNINGHAM, Legislative Director, Office of the
Commissioner, Department of Health and Social Services, answered
questions about HB 119 on behalf of the sponsor, House Rules, by
request of the governor. She said that subsection (b), which is
the section that refers to the subacute mental health facility,
is somewhat confusing because the legislation has not been
introduced yet. She said that hopefully when the legislation is
introduced, it will be apparent how it all interrelates and how
it enhances work that was started by Representative Claman last
session with Senate Bill 20. She commented DHSS looks forward
to having a dialogue with the legislature [regarding the
different legislation as it goes through the legislative
process].
CO-CHAIR SNYDER asked if Ms. Cunningham could speak to the
rationale for the change.
MS. CUNNINGHAM replied that through working with the Alaska
Mental Health Trust and the Division of Behavioral Health, and
looking at other models used throughout the U.S., particularly
one in Pheonix, Arizona, a forthcoming definition such as
"subacute mental health facility" would be a better description
for the type of center. She commented that it should be looked
at as a whole in the entirety of the legislation, as well as the
pathway in the involuntary commitment process.
4:33:05 PM
CO-CHAIR SNYDER opened public testimony on HB 119. After
ascertaining that there was no one who wished to testify, she
closed public testimony.
[HB 119 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| (H)HSS, 3.29-4.2 Meeting Notice.pdf |
HHSS 3/30/2021 3:00:00 PM |
|
| SB 70 v. B.PDF |
HHSS 3/30/2021 3:00:00 PM |
SB 70 |
| SB 70 Sponsor Statement 2.10.21.pdf |
HHSS 3/30/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 Summary of Changes v. A-B.pdf |
HHSS 3/30/2021 3:00:00 PM |
SB 70 |
| SB 70 Sectional Summary v B.pdf |
HHSS 3/30/2021 3:00:00 PM |
SB 70 |
| SB 70 Naloxone Standing Order Fact Sheet1-21-21.pdf |
HHSS 3/30/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 Opioid Leg Report DHSS 9.28.20.pdf |
HHSS 3/30/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 Opioid Leg Report DHSS 2017-18.pdf |
HHSS 3/30/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 FN DHSS.pdf |
HHSS 3/30/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 SLA 2017 SB 91.PDF |
HHSS 3/30/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 70 |
| SB 70 DHSS Invited Testimony - SHSS - 02162021.pdf |
HHSS 3/30/2021 3:00:00 PM |
SB 70 |
| SB 70 DHSS Invited Testimony - SHSS - 02162021.pdf |
HHSS 3/30/2021 3:00:00 PM |
SB 70 |
| SB 70 CS for SB 70 (HSS) v B.pdf |
HHSS 3/30/2021 3:00:00 PM SHSS 2/18/2021 1:30:00 PM |
SB 70 |
| SB 70 LOS 3.1.21.pdf |
HHSS 3/30/2021 3:00:00 PM |
SB 70 |
| HB 119 Transmittal Letter.pdf |
HHSS 3/30/2021 3:00:00 PM |
HB 119 |
| HB 119 Version 32 GH 1708 A.PDF |
HHSS 3/30/2021 3:00:00 PM |
HB 119 |
| HB 119 Sectional Analysis Version GH 1708 A.pdf |
HHSS 3/30/2021 3:00:00 PM |
HB 119 |
| HB0119-1-2-030121-DHS-Y.PDF |
HHSS 3/30/2021 3:00:00 PM |
HB 119 |
| HB0119-3-2-030121-DHS-Y.PDF |
HHSS 3/30/2021 3:00:00 PM |
HB 119 |
| HB0119-2-2-030121-DHS-Y.PDF |
HHSS 3/30/2021 3:00:00 PM |
HB 119 |
| HB 119 Adult Foster Care for Disabled Graphic.pdf |
HHSS 3/30/2021 3:00:00 PM |
HB 119 |
| SB 70 DHSS Invited Testimony - HHSS- 03302021.pdf |
HHSS 3/30/2021 3:00:00 PM |
SB 70 |
| ACEP SB70 Letter of Support.pdf |
HHSS 3/30/2021 3:00:00 PM |
SB 70 |