Legislature(2021 - 2022)DAVIS 106
03/29/2022 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB392 | |
| HB292 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 292 | TELECONFERENCED | |
| *+ | HB 392 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 292-HOME AND COMMUNITY-BASED WAIVER SERVICES
3:35:38 PM
CO-CHAIR SNYDER 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."
CO-CHAIR SNYDER provided a quick recap of HB 292. She explained
that the bill would help the state meet the growing need for
home and community-based care within Alaska by addressing some
of the challenges the Department of Health and Social Services
(DHSS) is facing and aiding the department in providing these
required services. She listed the three main components of the
bill: increasing the threshold for reducing services, providing
a pathway for restoring previously cut hours and services, and
allowing family members to be compensated for providing care.
She highlighted those available online to answer questions and
proceeded to the consideration of amendments.
3:38:31 PM
The committee took a brief at-ease.
3:38:37 PM
CO-CHAIR SNYDER noted that Amendment 1 would not be offered.
3:39:05 PM
CO-CHAIR SNYDER moved to adopt Amendment 2 to HB 292, labeled
32-LS1344\B.4, Foote, 3/19/22, which read:
Page 1, line 14, through page 2, line 1:
Delete ", reduce payment for services,"
Page 2, lines 23 - 31:
Delete all material and insert:
"(3) for purposes of a reduction in the
level of personal care and chore services under 42
U.S.C. 1396n(k) or Medicaid personal care services
under 42 U.S.C. 1396 - 1396p (Title XIX, Social
Security Act), the annual assessment must find that
the recipient's condition has materially improved
since the previous assessment; in [FOR PURPOSES OF]
this paragraph, "materially improved" means that a
recipient who has previously qualified for services is
able to function in a home setting with the reduced
level of services;
(4) for purposes of a termination of
payment for services, the annual assessment must find
that the recipient's condition has materially improved
since the previous assessment; in this paragraph,
"materially improved" means that a recipient who has
previously qualified for a service [A WAIVER] for"
Page 3, line 8:
Delete "and live independently"
Delete "waiver"
Insert "[WAIVER]"
Page 3, line 13:
Delete "and live independently"
Delete "waiver"
Insert "[WAIVER]"
Page 3, line 15:
Delete "(4)"
Insert "(5)"
Page 3, lines 25 - 27:
Delete "a person who is qualified to provide
personal care services under the 1915(k) state plan
option under 42 U.S.C. 1396n or"
Page 4, line 19:
Delete "payment for services or"
Page 4, line 23:
Delete "a reduction in payment for services or"
REPRESENTATIVE ZULKOSKY objected for the purpose of discussion.
3:39:12 PM
CO-CHAIR SNYDER listed the changes proposed in the amendment,
which reflected requests from the department and stakeholders.
First, she explained that the amendment would remove language
concerning payment for services that requires the department to
do [time consuming] individual evaluations and does not align
with the current structure for payment rate. She stated that a
forthcoming amendment may give the committee the opportunity to
address the rate setting process. She continued to the next
change in Amendment 2 which would replace language around
service level reductions to narrow the scope of the bill to only
personal care services, as these were the services most used by
stakeholders. She referred to conversations with the department
that support the change as it would lessen the administrative
cost associated with implementation. She moved on to the next
component of the amendment which would remove the language "live
independently" from the section of the bill describing the
services to be provided by the state. She explained that while
it is the intent of her office as the bill's sponsor to support
Alaskans' access to services that allow them to live
independently, she had received feedback from the department and
other stakeholders that more research into assessment and the
development of an inclusive definition of "living independently"
would be prudent before including that language in statute.
Last, she explained that the amendment would clarify language
defining "independent healthcare providers" to remove the
"certified" requirement, since registered nurses and APRNs are
qualified to provide independent assessments.
3:44:02 PM
REPRESENTATIVE ZULKOSKY removed her objection. There being no
further objection, Amendment 2 was adopted.
3:44:21 PM
REPRESENTATIVE SPOHNHOLZ moved to adopt Amendment 3 to HB 292,
labeled 32-LS1344\B.5, Foote, 3/16/22, which read:
Page 4, following line 15:
Insert a new bill section to read:
"* Sec. 5. The uncodified law of the State of
Alaska is amended by adding a new section to read:
REPORT TO THE LEGISLATURE. Not later than one
year after the effective date of secs. 1 - 4 this Act,
the Department of Health and Social Services shall
submit a report to the senate secretary and chief
clerk of the house of representatives and notify the
legislature that the report is available. The report
must
(1) include an assessment of the payment
rates for home and community-based services in the
state under a waiver or 1915(k) state plan option
under 42 U.S.C. 1396n(k); the assessment must address
the adequacy of those rates to ensure sufficient
workforce needs for independent qualified health care
professionals; and
(2) assess and identify the adequacy of
services under AS 47.07.045(a); this analysis shall
include the number of individuals eligible for
services, the number of individuals receiving
services, the average length of time for which an
individual is placed on a waitlist for services, and
the average hours of service each recipient receives
annually, monthly, and weekly; and
(3) assess and recommend additional changes
to state statute, regulations, and payment for
services to enhance the delivery of services under
AS 47.07.045(a) to individuals eligible to receive
care, particularly changes involving decreasing
waitlists, reducing services, and addressing workforce
shortages."
Renumber the following bill sections accordingly.
Page 5, line 3:
Delete "Section 5"
Insert "Section 6"
Page 5, line 12:
Delete "sec. 6"
Insert "sec. 7"
Page 5, line 17:
Delete "sec. 8"
Insert "sec. 9"
Page 5, line 18:
Delete "Sections 5 and 7"
Insert "Sections 6 and 8"
CO-CHAIR SNYDER objected for the purpose of discussion.
3:44:26 PM
REPRESENTATIVE SPOHNHOLZ explained that Amendment 3 would
require the department to create a one-time report on the
payment rates for home- and community-based services. She
referred to testimony from the public that low wages for
caregivers may be contributing to the lack of access to needed
services. She stated that Alaska is facing a crisis in elderly
care that will only get worse as the population ages, and the
proposed report would provide the legislature with visibility
into the issue and recommendations on how to improve service
availability.
CO-CHAIR SNYDER removed her objection. There being no further
objection, Amendment 3 was adopted.
3:46:16 PM
The committee took an at-ease from 3:46 p.m. to 3:56 p.m.
3:56:05 PM
CO-CHAIR SNYDER asked Representative McCarty to confirm whether
the adopted Amendment 2 accurately reflected the proposed
changes in Amendments 4 and 6. She mentioned her understanding
that Amendment 4 mirrored changes already occurring in Amendment
2, but that it included the removal of additional language about
reducing service levels.
3:58:29 PM
The committee took an at-ease from 3:58 p.m. to 4:03 p.m.
4:04:06 PM
REPRESENTATIVE MCCARTY moved to adopt Amendment 4 to HB 292,
labeled 32-LS1344\B.6, Foote, 3/17/22, which read:
Page 1, line 14, through page 2, line 1:
Delete ", reduce payment for services, or reduce
the level of services"
Page 2, lines 23 - 31:
Delete all material and insert:
"(3) the annual assessment must find that
the recipient's condition has materially improved
since the previous assessment; for purposes of this
paragraph, "materially improved" means that a
recipient who has previously qualified for a waiver
for"
Page 4, lines 16 - 25:
Delete all material.
Renumber the following bill sections accordingly.
Page 5, lines 1 - 3:
Delete all material.
Renumber the following bill sections accordingly.
Page 5, line 12:
Delete "sec. 6"
Insert "sec. 5"
Page 5, line 17:
Delete "sec. 8"
Insert "sec. 6"
Page 5, line 18:
Delete all material.
CO-CHAIR SNYDER objected for the purpose of discussion.
4:04:11 PM
REPRESENTATIVE MCCARTY confirmed that Amendment 2 addressed most
of Amendment 4, aside from the removal of the language regarding
reducing of the level of service. He shared that leaving this
language in the bill may prohibit a reduction of service level
if the "medical necessity" of the patient were to decrease or
the patient were to request a service level reduction. He
offered his understanding that removing the language would
increase flexibility.
CO-CHAIR SNYDER voiced her belief that protecting the ability to
appeal a reduction of services was a key component of the bill
and opined that the amendment would "gut" that component. She
mentioned that another section of the amendment would prevent
retroactive assistance for people who have had their services
reduced in the recent past. She stated that she could not
support the proposed amendment.
REPRESENTATIVE MCCARTY reiterated his concern that by not
removing the language about the level of service from the bill,
those receiving care could not receive less service if their
needs lessened.
CO-CHAIR SNYDER maintained her objection.
A roll call vote was taken. Representative McCarty voted in
favor of Amendment 4 to HB 292. Representatives Snyder,
Zulkosky, Sponholz, and Fields voted against it. Therefore,
Amendment 4 failed by a vote of 1-4.
4:10:06 PM
REPRESENTATIVE MCCARTY moved to adopt Amendment 5 to HB 292,
labeled 32-LS1344\B.7, Foote, 3/17/22, which read:
Page 2, lines 3 - 4:
Delete "an annual"
Insert "a biennial [AN ANNUAL]"
Page 2, line 7:
Delete "annual"
Insert "biennial"
Page 2, line 24:
Delete "annual"
Insert "biennial [ANNUAL]"
Page 2, line 30:
Delete "annual"
Insert "biennial"
CO-CHAIR SNYDER objected for the purpose of discussion.
REPRESENTATIVE MCCARTY shared his understanding that to continue
to qualify for care services though DHSS, recipients must
provide an annual assessment through an independent
practitioner. He referred to testimony that had revealed
service recipients were struggling to find practitioners who
could provide these assessments. He asked for a statement from
DHSS about its reaction to the proposed amendment.
4:11:24 PM
JOHN LEE, Director, Division of Senior and Disabilities
Services, Department of Health and Social Services, introduced
himself for the record.
REPRESENTATIVE MCCARTY asked whether changing from an annual to
a biennial assessment would be helpful for the department.
MR. LEE explained that there was a classification of people who
receive personal care services that require facility level
treatment, and annual assessments for this population helps
reduce the risk of institutionalization. Comparatively, he
explained that people who are being served using Personal Care
Attendants (PCAs) are at a lower risk for institutionalization,
so rather than assessing all recipients annually, the department
does an assessment on 10 percent of requests for renewal of
services. A drastic change in a person's condition may also
trigger an assessment, but he reported that there is no
statutory requirement for DHSS to assess annually, and it would
be a labor-intensive process to change from assessing 10 percent
of recipients to testing all recipients biennially.
REPRESENTATIVE MCCARTY withdrew Amendment 5.
4:14:19 PM
REPRESENTATIVE MCCARTY moved to adopt Amendment 6 to HB 292
labeled, 32-LS1344\B.8, Foote, 3/17/22, which read:
Page 2, line 26:
Delete "and live independently"
Page 3, line 8:
Delete "and live independently"
Page 3, line 13:
Delete "and live independently"
CO-CHAIR SNYDER objected for the purpose of discussion.
REPRESENTATIVE MCCARTY explained that Amendment 6 would remove
an occurrence of the "or live independently" language that
Amendment 2 had missed. He confirmed that the rest of Amendment
6 was covered by Amendment 2.
4:15:15 PM
The committee took a brief at-ease.
4:15:20 PM
REPRESENTATIVE MCCARTY clarified that the necessary language was
included in Amendment 2 and withdrew Amendment 6.
[HB 292 was held over.]
| Document Name | Date/Time | Subjects |
|---|---|---|
| 5. HB 392 Research - POLST FAQ 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 4. HB 392 Research - One Pager, 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 6. HB 392 Research - POLST Signature Requirement by state 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 3. HB 392 Sectional Analysis version A.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 2. HB 392 Sponsor Statement version A.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 8. HB 392 LOS since 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 7.HB 392 Research - APRN Practice Maps 3.28.22.pdf |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| 1. HB 392 version A.PDF |
HHSS 3/29/2022 3:00:00 PM HHSS 4/14/2022 3:00:00 PM |
HB 392 |
| HB 292 Amendment Packet, 3.22.22.pdf |
HHSS 3/22/2022 3:00:00 PM HHSS 3/29/2022 3:00:00 PM |
HB 292 |
| HB 292 Amendments with votes.pdf |
HHSS 3/29/2022 3:00:00 PM |
HB 292 |