03/28/2023 09:00 AM Senate FINANCE

SENATE BILL NO. 57                                                                                                            
                                                                                                                                
     "An Act  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."                                                                            
                                                                                                                                
9:45:58 AM                                                                                                                    
                                                                                                                                
TONY  NEWMAN, DIRECTOR,  SENIOR  AND DISABILITIES  SERVICES,                                                                    
DEPARTMENT OF HEALTH, discussed  the presentation, "State of                                                                    
Alaska Department  of Health" (copy  on file). He  looked at                                                                    
slide 2,  "Senior and Disabilities Services    Medicaid Home                                                                    
and Community Based Waivers":                                                                                                   
                                                                                                                                
     • Allow people with  disabilities and seniors to remain                                                                    
     in their  homes or  local community settings  when they                                                                    
     would otherwise need institutional care                                                                                    
     •  Home  and  Community  Based Waivers  receive  a  50%                                                                    
     Federal and 50% General Fund Match                                                                                         
     •  Alaska   provides  five  home   and  community-based                                                                    
     waivers:                                                                                                                   
     •Intellectual  and  Developmental  Disabilities  waiver                                                                    
     (serving about 2,000 people)                                                                                               
     •Alaskans Living Independently waiver (2,200 people)                                                                       
     •Children with  Complex Medical Conditions  waiver (225                                                                    
     people)                                                                                                                    
     •Adults  with  Physical  &  Developmental  Disabilities                                                                    
     waiver (144 people)                                                                                                        
     •Individualized Supports waiver (500 people)                                                                               
                                                                                                                                
Mr. Newman looked at slide 3, "Services available under                                                                         
Alaska's Medicaid Home and Community-Based Waivers":                                                                            
                                                                                                                                
     •  Residential Habilitation  (Group  Home, Family  Home                                                                    
     Habilitation)                                                                                                              
     • In-Home Supports                                                                                                         
     • Supported Living                                                                                                         
     • Day Habilitation                                                                                                         
     • Adult Day Services                                                                                                       
     • Respite                                                                                                                  
     • Supported Employment                                                                                                     
     • Transportation                                                                                                           
     • Environmental Modifications                                                                                              
     • Meals                                                                                                                    
     • Specialized Medical Equipment                                                                                            
     • Nursing Oversight                                                                                                        
     • Intensive Active Treatment                                                                                               
     • Specialized Private Duty Nursing                                                                                         
                                                                                                                                
Mr. Newman pointed to slide 4, "Options for 24/7                                                                                
residential care for people on Medicaid home and community-                                                                     
based waivers":                                                                                                                 
                                                                                                                                
     Assisted Living Home                                                                                                       
     Available for four waivers                                                                                                 
          Alaskans Living Independently (ALI)                                                                                   
          Alaskans    with   Physical    and   Developmental                                                                    
          Disabilities (APDD)                                                                                                   
          Intellectual and Developmental Disabilities (IDD)                                                                     
          Children with Complex Medical Conditions (CCMC)                                                                       
     Number of residents only limited by size of facility                                                                       
     Multiple administrative requirements                                                                                       
     Varying staffing patterns possible                                                                                         
                                                                                                                                
     Adult Care Home (proposed)                                                                                                 
     Available for four waivers:                                                                                                
          Alaskans Living Independently (ALI)                                                                                   
          Adults    with    Physical    and    Developmental                                                                    
          Disabilities (APDD)                                                                                                   
          Intellectual and Developmental Disabilities (IDD)                                                                     
          Children with Complex Medical Conditions (CCMC)                                                                       
     1 to 2 residents                                                                                                           
     Less administrative requirements                                                                                           
     Live-in caregiver                                                                                                          
                                                                                                                                
9:52:25 AM                                                                                                                    
                                                                                                                                
Co-Chair Olson wondered how many other states had a similar                                                                     
model, and how successful were those states.                                                                                    
                                                                                                                                
Mr. Newman replied that many states had the model, but most                                                                     
called the program different names. He stated that it was                                                                       
determined that it was a positive situation.                                                                                    
                                                                                                                                
Senator  Kiehl  surmised that  the  bill  did not  limit  to                                                                    
people aging out of the foster care system.                                                                                     
                                                                                                                                
Mr. Newman agreed.                                                                                                              
                                                                                                                                
Senator Kiehl  wondered whether it  was a new form  of care,                                                                    
or filling a limited gap.                                                                                                       
                                                                                                                                
Mr. Newman replied that the goal  was for two people to live                                                                    
together, but it allowed for up to three people.                                                                                
                                                                                                                                
Senator   Kiehl  asked   for   a   definition  of   "unusual                                                                    
circumstances."                                                                                                                 
                                                                                                                                
Mr. Newman  replied that  the situation  would be  for three                                                                    
disabled people to want to stay together.                                                                                       
                                                                                                                                
9:55:11 AM                                                                                                                    
                                                                                                                                
Co-Chair Olson wondered whether there was an age limit.                                                                         
                                                                                                                                
Mr.  Newman replied  that any  qualified individual  over 18                                                                    
was eligible for the service.                                                                                                   
                                                                                                                                
Senator Kiehl wondered who would draft the plan of care.                                                                        
                                                                                                                                
Mr. Newman replied  that the plan of care was  set up by the                                                                    
recipient with help from a  care coordinator and approved by                                                                    
the department.                                                                                                                 
                                                                                                                                
Senator Kiehl asked  where the type of care  home would have                                                                    
an exemption.                                                                                                                   
                                                                                                                                
Mr.  Newman responded  that Section  4 would  add it  to the                                                                    
setting list.                                                                                                                   
                                                                                                                                
Senator  Kiehl  noted  that   the  department  had  recently                                                                    
expanded  its definition  of "assisted  living  home" for  a                                                                    
number of  facilities, so  he hoped that  it would  not take                                                                    
away care.                                                                                                                      
                                                                                                                                
Co-Chair  Olson  queried  the   difficulty  in  receiving  a                                                                    
license.                                                                                                                        
                                                                                                                                
Mr. Newman replied  that Mr. Nave would be able  to reply to                                                                    
that question.                                                                                                                  
                                                                                                                                
9:57:48 AM                                                                                                                    
                                                                                                                                
ROBERT  NAVE,   PROGRAM  MANAGER,  DIVISION   OF  HEALTHCARE                                                                    
SERVICES,    DEPARTMENT    OF   HEALTH,    ANCHORAGE    (via                                                                    
teleconference),  explained that  the  process  to obtain  a                                                                    
license was not very cumbersome for providers.                                                                                  
                                                                                                                                
Co-Chair Olson  queried the  difficulty for  rural residents                                                                    
to obtain a license.                                                                                                            
                                                                                                                                
Mr.  Nave stated  that the  objective  for the  bill was  to                                                                    
relieve that difficulty.                                                                                                        
                                                                                                                                
Mr. Newman agreed.                                                                                                              
                                                                                                                                
10:00:08 AM                                                                                                                   
                                                                                                                                
Mr. Newman provided an overview of the fiscal notes.                                                                            
                                                                                                                                
Senator  Bishop  wondered why  the  positions  could not  be                                                                    
located in Anchorage.                                                                                                           
                                                                                                                                
Mr.  Newman  replied  that  they   could  be  in  Juneau  or                                                                    
Fairbanks.                                                                                                                      
                                                                                                                                
10:03:19 AM                                                                                                                   
                                                                                                                                
Co-Chair Olson OPENED public testimony.                                                                                         
                                                                                                                                
10:03:48 AM                                                                                                                   
                                                                                                                                
MICHELE   GIRAULT,   EXECUTIVE  DIRECTOR,   HOPE   COMMUNITY                                                                    
RESOURCES, ANCHORAGE (via  teleconference), spoke in support                                                                    
of the bill.                                                                                                                    
                                                                                                                                
10:05:52 AM                                                                                                                   
                                                                                                                                
JAMIE    KOKOSZKA,   PROGRAM    COORDINATOR,   COUNCIL    ON                                                                    
DISABILITIES    AND   SPECIAL    EDUCATION,   PALMER    (via                                                                    
teleconference), testified in support of the legislation.                                                                       
                                                                                                                                
10:08:46 AM                                                                                                                   
                                                                                                                                
Mr. Nave stated that he did not need to testify.                                                                                
                                                                                                                                
10:09:02 AM                                                                                                                   
                                                                                                                                
PAMELA  SAMASH,  ALASKA  COMMISSION ON  AGING,  NENANA  (via                                                                    
teleconference), spoke in support of the bill.                                                                                  
                                                                                                                                
10:10:56 AM                                                                                                                   
                                                                                                                                
MICHAEL  JEFFERY,  SELF,   UTQIAGVIK  (via  teleconference),                                                                    
testified in support of the bill.                                                                                               
                                                                                                                                
10:13:35 AM                                                                                                                   
                                                                                                                                
MARGE  STONEKING, ADVOCACY  DIRECTOR,  AARP, ANCHORAGE  (via                                                                    
teleconference), spoke in support of the legislation.                                                                           
                                                                                                                                
10:16:16 AM                                                                                                                   
                                                                                                                                
KIM CHAMPNEY, DIRECTOR,  ALASKA ASSOCIATION ON DEVELOPMENTAL                                                                    
DISABILITIES, spoke in support of the bill.                                                                                     
                                                                                                                                
Mr. Newman thanked the committee for hearing the bill.                                                                          
                                                                                                                                
Senator  Merrick  wondered  whether  people had  to  pay  to                                                                    
become licensed as an assisted living home.                                                                                     
                                                                                                                                
Mr. Newman replied  that there was a small  license fee, and                                                                    
the bill proposed to eliminate that license fee.                                                                                
                                                                                                                                
10:20:18 AM                                                                                                                   
                                                                                                                                
Senator Kiehl  queried the definition of  "business site" in                                                                    
Section 5.                                                                                                                      
                                                                                                                                
Mr. Newman agreed to provide that information.                                                                                  
                                                                                                                                
Mr.  Nave replied  that there  was  requirement that  stated                                                                    
that  no other  business could  be run  from the  home other                                                                    
than the  assisted living business, without  the approval of                                                                    
the department.                                                                                                                 
                                                                                                                                
SB  57  was   HEARD  and  HELD  in   committee  for  further                                                                    
consideration.