Legislature(2023 - 2024)ADAMS 519
04/26/2023 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| Governor's Appointments: Brett Huber, Alaska Oil and Gas Conservation Commission; Robert Doyle, Regulatory Commission of Alaska | |
| SB57 | |
| SB58 | |
| HB28 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 58 | TELECONFERENCED | |
| + | SB 57 | TELECONFERENCED | |
| + | SB 58 | TELECONFERENCED | |
| + | HB 28 | TELECONFERENCED | |
| + | TELECONFERENCED |
CS FOR SENATE BILL NO. 57(FIN) am
"An Act relating to home- and community-based services
under the medical assistance program; relating to
medical assistance for recipients of Medicaid waivers;
establishing an adult care home license and
procedures; providing for the transition of
individuals from foster care to adult home care
settings; and providing for an effective date."
2:11:25 PM
Co-Chair Foster asked to hear from the Department of Health
(DOH) on changes made to the legislation by the Senate. He
noted the bill was the Senate version of HB 58 related to
Medicaid assistance for adult homecare.
TONY NEWMAN, DIRECTOR, SENIOR AND DISABILITIES SERVICES,
DEPARTMENT OF HEALTH, thanked the committee for hearing the
bill. The bill was the companion bill to HB 58, which he
had presented to the committee the previous week. He
reviewed the differences between the two bills. He
explained that SB 57 included new language that would allow
certain family members and others with a legal duty to
support an individual to be allowed to be paid to provide
personal care services to the individual under one of the
Medicaid programs. The program was called Community First
Choice (CFC) authorized under a subsection of the federal
Social Security Act known as the 1915(k). Currently, under
department regulations, certain family members including
spouses, parents of minor children, and adult children of
parents who were assigned guardianship, were prohibited
from being paid to provide Medicaid funded personal care or
home and community based waiver services unless a court
order allowed it. He detailed that the prohibition had been
lifted under the public health emergency out of concern
that people would not be able to find caregivers during the
pandemic.
Mr. Newman continued to speak to the bill. He explained
that the workforce shortages seen throughout the healthcare
sector had been especially acute for providers of home and
community based services. The experience the department
gained offering the flexibility [under the public health
emergency] as well as the findings from a provider survey,
conversations with stakeholders, and national experience,
had all suggested that with the proper safeguards the
change could be continued on a permanent basis. The bill
would allow a limited subset of people receiving Medicaid
funded personal care to have a spouse or guardian be paid
to help them with their bathing, feeding, or other
activities of daily living.
Mr. Newman relayed that if the bill passed and was signed
by the governor, the department would write regulations
that would enable it to ensure the program was done in a
way that would ensure the safety and wellbeing of
individuals receiving care. He emphasized that the original
adult homecare aspects of the bill and the additional new
pieces, would both be administered by the Division of
Senior and Disabilities Services, but the bills did not
directly impact each other otherwise. He detailed that
adult homecare would be a waiver service, not a 1915(k)
service; therefore, legally responsible individuals would
not provide adult homecare to someone in their care. He
stated that more details would have to be worked out
through a careful regulatory development process that would
include stakeholders. He noted an individual available
online for questions and/or comment.
2:15:04 PM
Co-Chair Foster stated his understanding that another bill
had been rolled into the legislation. He which Senate Bill
had been added to the legislation.
Mr. Newman responded that SB 106 had been rolled into the
legislation.
Co-Chair Foster asked for verification that the fiscal
notes had not changed.
Mr. Newman replied that the fiscal notes had been prepared
to reflect the new narrative, but there was no change to
the amounts.
Representative Josephson referenced Mr. Newman's statement
that adult homecare would be a regular waiver and not a
1915(k). He asked for clarification.
Mr. Newman responded that the original adult homecare bill
referred to a Medicaid waiver service. The allowance for
legally responsible individuals to provide personal care
that had been added to the bill was not a waiver service
and was referred to as a Community First Choice 1915(k)
service.
Representative Tomaszewski noted that Mr. Newman had used
the term "legally responsible individuals." He asked for a
definition of the term.
Mr. Newman replied that Alaska regulations referred to
individuals with a legal duty to support another
individual. He detailed that it included a spouse of a
recipient of services, the minor child of a parent, and an
individual with the legal duty to support the recipient
under state law (a guardian assigned by the court to an
individual). He explained they were the three types of
individuals needing care that would need to be amended
under the regulation.
Co-Chair Foster set an amendment deadline for Friday at
5:00 p.m. He requested any amendments to be sent to his
office.
Representative Josephson asked if the fiscal note was small
because the cost would primarily be borne by the federal
government. He noted he liked the bill. He asked how the
state would pay the people who had not been paid before. He
wondered if there would be additional fiscal notes
forthcoming.
Mr. Newman responded there were a couple of reasons there
would not be an increase in the Medicaid services bill to
the state. First, the bill would represent a very small
number of individuals. Currently, the CFC program served
around 850 people. He explained that a small subset of
those individuals would be seeking to have care provided by
a legally responsible individual. Second, the state was
seeing a "slow bleed of providers" of home and community
based services. There had been a decrease in the number of
people served because of a loss of providers. He did not
believe the bill would increase the pool of providers so
much that it would stop the bleed of providers. He reported
that the state had been offering the service under the
pandemic and had not seen an increase in cost. The bill
would mean maintaining flexibility for a small subset of
people.
Representative Josephson asked for verification that the
slow bleed Mr. Newman was referring to meant that some of
the non-familial providers were no longer providing the
services and the bill would mean familial connections would
get reimbursed for their good efforts.
2:20:50 PM
Mr. Newman agreed.
Co-Chair Foster noted that Co-Chair Edgmon joined the
meeting. He remarked that Alexis Rodich was available
online. He asked Mr. Newman if the individual was available
for questions or had testimony to provide.
Mr. Newman relayed that Ms. Rodich had worked closely with
the sponsors in the development of the bills. He noted she
may have a comment and was also available for questions.
Representative Coulombe asked if the bill covered foster
parents and adults taking care of their elderly parents.
Mr. Newman replied that the bill covered adults taking care
of their elderly parents if they were assigned guardianship
of the parent. He remarked that the adults would currently
be allowed if they were not assigned guardianship because
they were not guardians. He noted it was not currently a
prohibition in place. Under the regulation 7 AAC 127.015, a
foster parent was not considered an individual with a legal
duty to support a recipient. He noted it would remain
unchanged.
Representative Coulombe thought the bill aimed to fix a
situation pertaining to disabled foster children through
adulthood.
Mr. Newman agreed that the original adult homecare bill was
designed to provide better service to foster children aging
out of foster care. The two bills were not connected in
that way. He elaborated that the legally responsible
individual portions of the bill would not be related to the
adult foster care portions of the bill. Both would be
administered by the Division of Senior and Disabilities
Services, but they were two different services.
2:23:34 PM
ALEXIS RODICH, SEIU-775, SEATTLE (via teleconference),
relayed that she was available for questions.
Co-Chair Foster restated the amendment deadline.
CSSB 57(FIN) am was HEARD and HELD in committee for further
consideration.