04/12/1996 08:20 AM House FIN

  HOUSE BILL NO. 528                                                           
                                                                               
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       "An  Act relating to  applications for  certificates of                 
       need  and  licensing  of nursing  homes;  amending  the                 
       standard of review for certificates  of need for health                 
       care facilities in the state; establishing a moratorium                 
       with respect  to new  applications  by prohibiting  the                 
       issuance  of  a certificate  of need  or a  license for                 
       additional  nursing home  capacity in  the  state until                 
       July 1, 1998; and providing for an effective date."                     
                                                                               
  HARLAN KNUDSON,  EXECUTIVE  DIRECTOR,  ALASKA  HOSPITAL  AND                 
  NURSING HOME ASSOCIATION testified on  HB 528.  He  provided                 
  members with  recommendations for  modifications  to HB  528                 
  (Attachment 1).  He maintained that HB 528 is an opportunity                 
  to create a plan to meet Alaska's long term care needs.                      
                                                                               
  Mr. Knudson  reviewed Attachment 1.   He  requested that  in                 
  section 1, subsections (1) and (2)  be deleted.  He observed                 
  that there were  764 licensed nursing  home beds in  January                 
  1992.   He  stressed that the  State pays  by the bed.   The                 
  occupancy  of nursing home  beds was  84 percent  in January                 
  1992.  Medicaid accounted  for 70 percent of occupancy.   He                 
  pointed out that  the pioneer home in  Ketchikan contributes                 
  to  the low occupancy rates.   There was 758 beds in January                 
  1, 1996.   He disagreed  that there is  an overabundance  of                 
  nursing home beds.  He noted  that occupancy of nursing home                 
  beds in Anchorage  and Fairbanks  is above 90  percent.   He                 
  maintained that the  moratorium requires rural residents  to                 
  send their elderly to urban areas.  He stressed the cultural                 
  difference between rural and urban areas.                                    
                                                                               
  Mr.  Knudson requested  that  section  2  be  deleted.    He                 
  maintained  that section  2  takes  responsibility from  the                 
  legislature.  Section  2 allows the  Department of Health  &                 
  Social Services to establish state policy on the  funding of                 
  new construction or  new services  for health facilities  in                 
  Alaska.  He  asserted that the  Department can deny  nursing                 
  home beds to protect its Medicaid budget.                                    
                                                                               
  Representative Martin maintained  that the executive  branch                 
  has  the  responsibility for  establishing  policy for  many                 
  state programs.   Representative Kelly pointed out  that the                 
  executive  branch  establishes  regulations   based  on  the                 
  statutes.   He maintained  that the  legislature establishes                 
  policy.                                                                      
                                                                               
  Mr. Knudson stated  that providers  and state agencies  have                 
  the responsibility  to  identify  the  needs  and  recommend                 
  policy  to  the   legislature  and   implement  the   policy                 
  directives of the legislature.   He emphasized that agencies                 
  should not  establish were  funding should  be provided  and                 
  overall policy.                                                              
                                                                               
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  Mr. Knudson noted that the  Alaska Hospital and Nursing Home                 
  Associations supports a one year  moratorium on nursing home                 
  beds.  He emphasized that this is the second year of a three                 
  year moratorium.  He  pointed out that a  study on the  long                 
  term care needs of Alaska was  contracted by the Division of                 
  Senior Services in  June 1995.   He stressed that the  study                 
  will  be  released  soon.    He  stated  that  if  the  next                 
  Legislature does not  agree with the recommendations  of the                 
  study the moratorium could be extended.                                      
                                                                               
  Mr. Knudson recommended that section 4 be amended to include                 
  a nursing  home administrator  and that  "working group"  be                 
  changed to  "planning group".   He stated that  the planning                 
  group should  propose a  plan identifying needs,  priorities                 
  and funding sources.                                                         
                                                                               
  Representative   Mulder   noted   that  proposed   committee                 
  substitute, Work  Draft 9-LS1731\F,  dated 4/11/96  reflects                 
  Mr. Knudson's request for deletion of  section 1 (1) and (2)                 
  (copy on file).  He added that the work draft provides a one                 
  year moratorium.                                                             
                                                                               
  HB 528 was HELD in Committee for further consideration.