04/15/2010 08:30 AM House FINANCE

CS FOR SENATE BILL NO. 32(FIN)                                                                                                
                                                                                                                                
     "An Act relating to medical assistance payments for                                                                        
     home and community-based services and provision of                                                                         
     personal care services in a recipient's home; and                                                                          
     providing for an effective date."                                                                                          
                                                                                                                                
8:26:33 PM                                                                                                                    
                                                                                                                                
SENATOR ELLIS, stated  that the current rate  system for the                                                                    
home  and community  based Medicaid  services is  broken. He                                                                    
noted that  Department of Health and  Social Services (DHSS)                                                                    
released  new regulations  that mimic  this bill.  He opined                                                                    
that the passage of SB 32  was necessary to fund the changes                                                                    
and ensure that they will  be maintained over time. Home and                                                                    
community based  Medicaid services are the  key to improving                                                                    
the  quality   of  life  for   seniors  and   children  with                                                                    
developmental disabilities.  He added that SB  32 creates an                                                                    
equitable  and predictable  process for  all long  term care                                                                    
providers. States with long  established high proportions of                                                                    
home  and   community  based  services  showed   an  overall                                                                    
decrease in  spending of  3 percent  between 1995  and 2005.                                                                    
While  home  and  community  based  services  are  optional,                                                                    
nursing homes are not.                                                                                                          
                                                                                                                                
8:29:41 PM                                                                                                                    
                                                                                                                                
Senator  Ellis  pointed  out  that long  term  care  is  the                                                                    
fastest growing  segment of the  Medicaid budget.  Growth is                                                                    
controlled by supporting home and community based services.                                                                     
                                                                                                                                
MAX  HENSLEY, STAFF,  SENATOR  ELLIS,  detailed a  sectional                                                                    
analysis. He noted  that Section 1, Page 1  details the rate                                                                    
review process.  He pointed out  that the rate  clauses must                                                                    
be  approved by  the  commissioner within  the current  cost                                                                    
containment statutes.  The cost surveys are  preformed every                                                                    
four years. He mentioned that  Section 2 creates a report to                                                                    
the legislature on  the trends of those  rates. He continued                                                                    
that Section 3  repeals that report after  2014. He finished                                                                    
with Section  4 including a  delayed effective date  of July                                                                    
1, 2011  to allow the  department to create  methodology for                                                                    
the cost surveys.                                                                                                               
                                                                                                                                
8:31:33 PM                                                                                                                    
                                                                                                                                
Representative  Gara noted  that  a person  must be  nursing                                                                    
home  eligible  in  order to  receive  the  community  based                                                                    
services.  Senator   Ellis  responded  that   hospitals  and                                                                    
nursing  homes   already  receive   rate  review   and  cost                                                                    
increases under  current statute.  Home and  community based                                                                    
services  are the  most humane,  cost  effective, and  least                                                                    
restrictive form  of care. The legislation  seeks to address                                                                    
the defective piece of the system.                                                                                              
                                                                                                                                
Mr.  Hensley stated  not all  persons who  receive home  and                                                                    
community  based  services  would be  eligible  for  nursing                                                                    
homes.  The vast  difference in  cost between  institutional                                                                    
care and  home based  services greatly outweighs  the larger                                                                    
number of people receiving waiver services.                                                                                     
                                                                                                                                
Representative Fairclough  asked about  Page 2, Lines  9 and                                                                    
10  and the  reference to  market basket  data. Mr.  Hensley                                                                    
responded  that market  basket data  was  the standard  home                                                                    
health  inflation  rate.  Last  year's  projection  was  2.8                                                                    
percent and this year's is 2.1 percent.                                                                                         
                                                                                                                                
Representative Fairclough noted that Page  2, Line 1 and the                                                                    
reference  to payment  established, the  word "of"  requires                                                                    
deletion.                                                                                                                       
                                                                                                                                
Vice-Chair Thomas asked if the  bill addresses personal care                                                                    
attendants.  He  wondered  if a  convicted  felon  would  be                                                                    
eligible as a personal care attendant.                                                                                          
                                                                                                                                
8:35:14 PM                                                                                                                    
                                                                                                                                
GWEN LEE,  ALASKA ASSOCIATION ON  DEVELOPMENTAL DISABILITIES                                                                    
(via  teleconference), stated  that  she is  a provider  who                                                                    
offers care  to children  and adults with  disabilities. She                                                                    
testified  in  support of  the  legislation.  She noted  the                                                                    
inequities  in  the  system  where  the  nursing  homes  and                                                                    
hospitals  receive the  regular  rate  review, however,  the                                                                    
providers  in  the  home  and  community  based  system  are                                                                    
critical to the system.                                                                                                         
                                                                                                                                
8:38:11 PM                                                                                                                    
                                                                                                                                
EMILY   ENNIS,    ALASKA   ASSOCIATION    ON   DEVELOPMENTAL                                                                    
DISABILITIES (via  teleconference), echoed the  testimony of                                                                    
Gwen  Lee. She  noted that  the support  is critical  to the                                                                    
long term care system in Alaska. She urged support.                                                                             
                                                                                                                                
Co-Chair Stoltze closed public testimony.                                                                                       
                                                                                                                                
Senator Ellis thanked the committee for the help.                                                                               
                                                                                                                                
SB  32  Was   HEARD  and  HELD  in   Committee  for  further                                                                    
consideration.