Legislature(2021 - 2022)DAVIS 106
03/03/2022 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB265 | |
| HB292 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HSCR 2 | TELECONFERENCED | |
| += | HB 265 | TELECONFERENCED | |
| *+ | HB 292 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
HB 292-HOME AND COMMUNITY-BASED WAIVER SERVICES
4:15:02 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be HOUSE BILL NO. 292, "An Act relating to home and
community-based services; and providing for an effective date."
4:15:41 PM
CO-CHAIR SNYDER, as prime sponsor, presented HB 292. She
explained that the proposed legislation is needed because of the
demand for in-home, long-term services and associated support.
She stated that stakeholders have reported service level cuts
for seniors, people with disabilities, and those who receive
Home and Community-Based Services (HCBS) waivers and Community
First Choice Medicaid State Plan K. She stated that these
people are facing barriers to services, such as long waitlists
and the inability to obtain the personal care assistant (PCA) of
their choice. She observed that caregivers have seen fewer
hours and lower pay over the last decade. She noted that rural
communities have been impacted by the lack of homecare
infrastructure. Because homecare is the only option which
allows these individuals to stay in their rural communities,
many Alaskans are forced to move away, denying them the option
of maintaining dignity and independence.
CO-CHAIR SNYDER stated that the proposed legislation outlines
the following issues: declining wages of PCAs; the impact on the
mostly female workforce; longer time spent on waitlists; budget
cuts; service level reductions; and the over reliance on unpaid
care. She stated that despite the growing need for personal
care services, services decreased from 2016 to 2020 by 23
percent. These cuts have left individuals reliant on the unpaid
labor of untrained friends and family, costing the state money
in terms of economic productivity. She expressed hesitancy in
reducing quality of life issues to economics, but "it is our job
as legislators."
4:21:09 PM
CO-CHAIR SNYDER explained that HB 292 would begin to help by
preventing unwanted service-level cuts for personal care
services by fixing the weak points in the statute. She
explained that assessments which result in service level
reductions would be required to go through the same detailed
process for service level terminations. She added that previous
service level cuts would be restored from 2019 to present.
Finally, she stated the proposed legislation would permit
legally responsible individuals to become PCAs under HCBS
waivers and Medicaid State Plan K. She concluded with the
example of a constituent who would be impacted by the proposed
legislation. She described the individual as having cerebral
palsy and using a wheelchair. The individual recently moved to
Anchorage for better access to PCAs, but in the 8-month search
one has not been found. It has not been economically feasible
for the family to travel back and forth to Anchorage to provide
care while working to support themselves. Recently the hours
allocated for the individual to have homecare were cut. She
described the situation as "a negative feedback loop." She
maintained that HB 292 would begin to address these issues.
4:25:11 PM
ALLIANA SALANGUIT, Staff, Representative Liz Snyder, Alaska
State Legislature, on behalf of Representative Snyder, prime
sponsor, paraphrased the sectional analysis of HB 292 [included
in the committee packet], which read as follows [original
punctuation provided]:
Sec. 1: Amends AS 47.07.045(a) Home and community-
based services for provisions in the section to apply
also to Community First Choice and Medicaid personal
care services programs.
Sec. 2: Amends AS 47.07.045(a) Home and community-
based services by:
Introducing a process in statute for reducing
hours or payment for home and community-based
services provided under 1915(k) state plan option
and Medicaid personal care services that mirrors
the process for terminating services.
• Adding "and live independently" as a condition
for terminating services.
• Requiring the department to continue following
notice requirements provided in later sections.
MS. SALANGUIT specified that the requirements for notification
indicated in Section 2 are further laid out in Section 8.
Passing ahead, she paraphrased from Section 8, which read as
follows [original punctuation provided]:
Sec. 8: Establishes the act will take effect only upon
federal approval of the state plan for medical
assistance, and that if approved, the Commissioner of
the Department of Health and Social Services must
notify the revisor of statute not later than 30 days
after receiving notice.
MS. SALANGUIT, picking up at Section 3, continued paraphrasing
the remaining sectional analysis, which read as follows
[original punctuation provided]:
Sec. 3: Amends AS 47.07.045(d) Home and community-
based services by:
• Moving definitions for "independent qualified
health care professional" and "independent
qualified waiver" to this section. It does not
create any new definitions.
"Independent qualified health care
professional" for an intellectual or
developmental disability waiver is defined as a
qualified intellectual disability professional
under 42 C.F.R. 483.430.
• For other allowable waivers, "Independent
health care professional" is defined as a person
who can provide personal care services under the
1915(k) state plan or a registered nurse with
specific qualifications relevant to the waivers.
Sec. 4: Adds a new subsection to AS 47.07.045 Home and
community-based services that:
• Establishes that once the department receives
the results of an assessment they have 10 days to
notify, in writing, the recipients or individuals
with legal authority to act on the recipient's
behalf of the assessment results.
• Establishes that after the department decides
if there will be a change in levels of services
or payments for services, they have 10 days after
the decision is made to notify the recipient or
individuals with legal authority to act on the
recipient's behalf of the decision. This notice
must be done in writing and 30 days before the
new determination goes into effect. The
department must also inform them they have a
right to appeal the decision.
• Allows legally responsible persons to provide
personal care services to an individual eligible
for home and community-based services waivers and
Community First Choice.
Sec. 5: Adds a new section that creates a path for
hours to be restored through the proposed reassessment
process for recipients of care whose payment for
services were reduced between January 1, 2019 and
January 1, 2022.
Sec. 6: Adds a new section to instruct the Department
of Health and Social Services to amend and submit a
state plan for medical services to the Centers for
Medicare and Medicaid Services (CMS).
Sec. 7: Makes section 5 retroactive to January 1,
2019.
Sec. 9-10: Create two effective dates:
• For sections 1 4, effective date will be the
day after the revisor of statutes receives
notification from the Commissioner of Health and
Social Services of federal approval of state plan
amendments.
• Sections 5 and 7 take effect immediately upon
passage
4:29:50 PM
KATHERINE BACON, representing self, stated that she had been the
primary caregiver for her medically fragile granddaughter. She
stated that her family had had no experience with special needs
individuals, "but we learned." Her granddaughter is now 24
years old. She continued that beginning in 2003 she became the
primary caregiver to her late husband suffering with Alzheimer's
disease. Now she is the primary caregiver [to his grandson,
Michael]. He had a traumatic brain injury when he was 3 months
old, which resulted in multiple lifelong issues. Even though he
was not expected to live, she said he would soon be 30 years
old. She shared that over the years she has hired and worked
"alongside more caregivers than I can count." She indicated
that she does not blame the caregivers, as they receive
inadequate pay and too few hours. She stated that caregivers
often have to "cobble together" full-time schedules by juggling
multiple clients or taking other jobs, and then, often, they
leave to take better jobs. The caregivers who stay cannot
provide sufficient care because they are overburdened and
exhausted. She stated that the needs of individuals do not go
away when hours are cut or caregivers are not available. She
explained that she is now Michael's sole care provider, 24 hours
a day, 7 days a week. She is fortunate she is paid to care for
Michael, but the process for families to be qualified to receive
care services, let alone to be paid, is long and hard. She
argued that the people who know and love the individual should
be able to care for them. She expressed the opinion that many
caregivers struggle, and there is a "breaking point," and the
proposed legislation would take the first step to repair the
broken system by reducing barriers for vulnerable Alaskans. She
thanked the bill sponsor.
4:35:14 PM
MS. BACON, in response to Representative Spohnholz, explained
that the process for her to be Michael's caregiver was not hard
because she is not biologically related to him; otherwise, there
are many steps, and it takes months. She stated that once the
process seems to be final, there will be "another whole list of
hoops." She added that she knows people who have been
disheartened and gave up. She expressed the opinion that it
would be better for individuals to be at home with family
[caregivers] as opposed to hiring people who may not "have their
heart in it." She suggested [caregivers may not be invested in
their clients] because of the low pay.
4:37:20 PM
The committee took a brief at-ease at 4:37 p.m.
4:37:29 PM
LEIONILEI JOHNSON, representing self, spoke in support of HB
292. She stated that she is a professional home health
provider. She shared that she is Tlingit and an Eagle from the
Thunderbird Clan. She said when she was a young girl, she had
helped her mother care for her grandmother. Without their help
her grandmother had no way to buy groceries, keep herself clean,
and take care of her home. She expressed pride in her ability
to help. She stated that she has been a professional caregiver
for 10 years and has witnessed hours cut for client care, even
for those who cannot get out of bed. In example, she shared
that a client with Parkinson's disease needed help with many
things. The client fell when left alone, but the state only
approved 15 hours of care a week. She stated that she was
worried, and the client was upset. After being in the hospital
with a broken hip, the client's home was lost, and she lost her
job. Against her convictions, she said, she applied for
government assistance. Working in a different job, she said
that she "made more money as a food runner in a restaurant" than
she made as a professional caregiver. She said the restaurant
job had been seasonal, and she became unemployed again. She
stated she is doing her best to help elders in the community,
but the system "is broken and it's hurting us all." She
asserted that restoring cut hours would help clients be safe and
help caregivers make a living.
4:42:47 PM
AMANDA COLLINS, representing self, spoke in support of HB 292.
She shared that she is a single mother and has been a caregiver
for her 10-year-old child with disabilities for the child's
entire life. She stated that her daughter's condition is
complex, with many challenges, and she lost her job because of
the needed full-time care. She indicated that she had applied
for government assistance, and her daughter was deemed eligible
for services, but the list had been so long the application
expired before services could be received. She stated that she
has had to reapply multiple times, but they still receive no
services. She expressed the opinion that she is the most
qualified person to take care of her daughter, but the
circumstances weigh heavily emotionally, financially, mentally,
and spiritually because she is totally dependent on social
services for the basics to survive "day to day." She said, "I
would love more than anything to be able to work and provide a
stable income," but this is impossible because of her daughter's
24-hour care. She argued that HB 292 would help by providing
pay to caregivers for the work they are already selflessly
doing. She stated it would give her a chance to be less
dependent on public assistance and an opportunity "not only to
survive, but to thrive."
4:46:03 PM
ALEXIS RODICH, Lobbyist, Service Employees International Union
(SEIU) 775, stated that over the last year SEIU has spent
significant time with caregivers in Alaska, speaking to them
about their experiences in making ends meet while "doing the
work they love." She stated that these caregivers are often
women, people of color, and from immigrant communities. She
cited that, while inflation is up, the wages of PCAs in Alaska
are lower than they were a decade ago. She opined that wages
are higher for jobs which have far less pressure or
consequences, yet "their love for the work" makes caregivers
want to stay in the profession. She said caregivers often take
on two or three jobs, or they are forced out of the profession,
which makes it much harder for those looking for a caregiver.
She cited that while pervasive budget cuts have resulted in
reductions in personal care services, Alaska has the fastest
growing senior population per capita in the country. She
reiterated that when caregiver's hours are cut the need does not
go away; friends and family end up providing unpaid labor, and
individuals are put in situations which could result in injury
or hospitalization. She stated that HB 292 would create the
initial steps to ensure those who need services and support are
getting the level of care they need, allowing for dignity and
independence in their own homes. It would also give stability
to caregivers providing these services. She thanked the bill
sponsor and the committee.
4:50:11 PM
JOHN LEE, Director, Division of Senior and Disabilities
Services, Department of Health and Social Services, in response
to Representative Prax, explained that PCA certification depends
on the agency and its requirements. The basic requirements
would be passing a background check, completing first aid
training, and completing training related to the skills needed
for the client. He said there are various requirements
depending on whether the individual will be supporting a client
on a waiver program or a state plan.
REPRESENTATIVE PRAX, repeating the question for Ms. Johnson,
stated that he is trying to understand the effort required to
obtain certification.
4:53:54 PM
MS. JOHNSON explained it depends on the client because each
client would require a certain type of care. She stated that an
individual would need a background check, certification in first
aid, and whatever training the company requires.
REPRESENTATIVE PRAX questioned whether the requirements would be
determined by the employer or prescribed by regulation.
MS. JOHNSON responded that in her training she was certified to
use a belt around the waist for helping the client move, to
change the bed if the client is bedridden, to use a lift on a
client, to bathe and clothe a client, and to use a feeding tube
and catheter. She stated that a nurse would administer
medication, and a physical therapist would work with the client.
4:56:39 PM
REPRESENTATIVE FIELDS voiced an observation that there has been
a net migration out of the state, which is a negative thing for
the economy. He stated that he has observed an entire
multigenerational family leave the state because they were
unable to find care for an elderly family member. He expressed
the opinion that keeping multigenerational families in the state
would be good from a humane perspective and an economic
perspective. He commented that the fiscal note on the bill is
"tiny," and it is a small price to pay for supporting families
in the state.
4:57:45 PM
CO-CHAIR ZULKOSKY announced that HB 292 was held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| CS HB 265 v N 03.01.22.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 265 |
| CS HB 265 v N Summary of Changes 03.02.22.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 265 |
| HB 265 Testimony - Received as of 03.02.22 - 1.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 265 |
| HB 265 Testimony - Received as of 03.02.22 - 2.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 265 |
| HB 265 Testimony - Received as of 03.02.22 - 3.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 265 |
| HB 265 Presentation 02.16.22.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 265 |
| HB 292, Sponsor Statement, Ver. A.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 292 |
| HB 292, Sectional Analysis.pdf |
HHSS 3/3/2022 3:00:00 PM |
HB 292 |
| HB0292A.PDF |
HHSS 3/3/2022 3:00:00 PM |
HB 292 |
| Kevin Fimon Resume 2021 AMHTA_Redacted.pdf |
HHSS 3/3/2022 3:00:00 PM |
Gov Appointee to Mental Health Trust Authority |