Legislature(2023 - 2024)BUTROVICH 205
03/02/2023 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB57 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 57 | TELECONFERENCED | |
| += | SB 8 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 57-ADULT HOME CARE; MED ASSISTANCE
3:31:28 PM
CHAIR WILSON announced the consideration of 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."
He stated that the intention is to hear the introduction and
take invited and public testimony.
3:32:26 PM
TONY NEWMAN, Acting Director, Division of Senior and
Disabilities Services, Department of Health, Juneau, Alaska,
stated that SB 57 would add to the array of services under the
Alaska Medicaid Home and Community-Based Wavier Program. He
provided a brief presentation to explain these waivers. He
paraphrased the following:
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)
He provided examples of individuals who might receive the
waivers. The idea of these waivers is to provide people with
more independence and personal choice and save the state
significant amounts of money.
3:34:17 PM
MR. NEWMAN displayed the array of services that are available
under Alaska's Medicaid Home and Community-Based Waivers. He
explained that some people receive just one of these services
while others receive many at the same time. Some of the services
are provided solely in assisted living homes and others can be
delivered in private homes. The common thread for people on
waivers is that they all rely on care coordinators to set up
support plans and help recipients maximize the resources in
their community. Care coordinators are people who are either
self-employed or they work for small agencies.
3:35:16 PM
MR. NEWMAN stated that SB 57 seeks to provide the people on
waivers with a new service option that would be offered in a new
type of licensed residential setting called an Adult Care Home.
The vision is for the service and setting to be less burdensome
administratively compared to existing assisted living homes but
still ensures the residents' care and safety. He described an
informal arrangement where a homeowner with a spare room offers
the space but does not provide the needed services. The support
service will ensure the safety and as much independence as
possible for the recipient and adequate support for the
caregiver.
MR. NEWMAN explained that constituents who were serving as
foster parents to children with severe disabilities who were
aging out of the foster system brought the idea for SB 57
forward. They found that the only available option was to turn
their home into an assisted living home which required licensure
and other red tape. After considering the matter, the department
realized that a new type of home care setting could be broadly
beneficial. SB 57 extends the possibility of adult home care to
individuals with disabilities, including seniors, who qualify
under the Medicaid Home and Community-Based Waiver Program. The
administrative expectations for adult care homes will be
different compared to assisted living homes. He acknowledged
that a lot of the details have yet to be worked out. Should the
bill pass, the department would develop regulations about the
credentials and training caregivers would need, the space
expectations, and pay, among other things. Input would be
solicited from all stakeholders. At this point, SB 57 provides
the conceptual framework to get started on this alternative.
CHAIR WILSON requested the sectional analysis.
3:38:36 PM
MR. NEWMAN presented the sectional analysis for SB 57.
SECTIONAL ANALYSIS
Senate Bill 57: Adult Home Care Services
Section 1. Adds a new section in AS 47.07, Medicaid
Assistance for Needy Persons, declaring that the
state shall pay for adult home care services for an
individual at a daily rate set by the department in
regulation for individuals on Medicaid who are at
least 18; enrolled in a home and community-based
waiver under AS 47.07.045; if the individual's
support plan is approved for adult home care
services; and if the person providing the services
to the individual holds an adult care home license
issued under AS 47.32. This section also allows
individuals to receive habilitative and
rehabilitative care in addition to adult home care
services and directs the department to adopt
regulations setting a rate for the service,
establish standards for operating an adult care
home, and establish a procedure for transitioning an
individual from a licensed foster care home to a
licensed adult care home. This section also directs
the department to establish a simple and efficient
process to allow a foster parent who holds a foster
home license issued under AS 47.32 to transition
from the foster home license to an adult care home
license for purposes of maintaining the placement of
and services provided to an individual who is
transitioning out of foster care, enrolled in a
waiver, and at least 18 years of age.
Section 2. Amends AS 47.32.010(b) to add a new entity,
"adult care homes," that shall be subject to the
centralized licensing functions of the department.
Section 3. Adds a new section to AS 47.33 that defines
the conditions under which the department may
license an adult care home. A person may be licensed
to operate such a home for an individual who is at
least 18 years of age and enrolled in Medicaid and
home and community-based waiver services. An adult
care home may provide 24-hour oversight and care for
up to two adults for compensation or reimbursement
under the adult home care service, allows the
department to establish standards in regulation to
authorize care for up to three individuals based on
unusual circumstances; and defines "care" as
providing for the physical, mental, and social needs
of an individual.
Section 4. Amends AS 47.32.900(2) to add adult care
homes to the list of settings that are not defined
as assisted living homes.
Section 5. Amends AS 47.32.900 to add a definition of
adult care home, meaning a licensed home, not a
business site, in which the adult head of household
resides and provides 24-hour care on a continuing
basis for eligible individuals.
Section 6. Amends uncodified law by adding a new
section that requires the Department of Health to
submit for approval by the United States Department
of Health and Human Services an amendment to the
state medical assistance plan, waivers, or an 1115
demonstration waiver as necessary to allow eligible
individuals to receive adult home care services and
other long-term care services that are not
duplicative.
Section 7. Amends uncodified law by adding a new
Conditional Effect Notification section specifying
that Section 1 takes effect if the United States
Department of Health and Human Services approves
amendments to the state plan submitted under Section
6 by July 1, 2027, and adds requires the
commissioner of health to notify the revisor of
statutes in writing within 30 days that those
amendments were approved.
Section 8. Provides for an effective date for any
portion of section 1 as the day after the revisor of
statutes receives notice from the commissioner of
health, per Section 7.
CHAIR WILSON asked the committee if there were any questions.
3:41:15 PM
SENATOR DUNBAR asked how many states have a system that's
exactly like what is being proposed and how many have something
similar.
MR. NEWMAN offered to do some research to determine which states
offer similar services. He explained that the challenge is that
states can name the program as they choose and the services
provided may differ somewhat because Medicaid waiver programs
are different in every state. Oregon, for example, has a similar
program but those homes are called Adult Foster Care Homes.
SENATOR DUNBAR asked whether the research shows that similar
programs are working.
MR. NEWMAN answered in the affirmative.
3:42:57 PM
SENATOR KAUFMAN asked whether somebody could declare their own
home a care facility and be paid to receive services.
MR. NEWMAN replied that's the kind of question the department
would need to discuss with the stakeholders and develop in
regulations to avoid conflicts of interest and prevent fraud,
waste, and abuse.
SENATOR KAUFMAN said he didn't think it was a bad idea for
people to stay in their own home but he wondered about
incentivizing something that might have occurred anyway. He
expressed interest in hearing how that sort of situation could
be filtered out by regulation.
3:44:27 PM
SENATOR GIESSEL recalled that during Covid a family member could
be paid for providing care for a person who was staying in their
own home.
MR. NEWMAN confirmed that under the public health emergency, the
Centers for Medicare & Medicaid Services (CMS) permitted the
department to lift the requirement that legally responsible
individuals could not be compensated to provide care. That is
still the case, but the state is looking at whether to continue
that option.
SENATOR GIESSEL asked whether the department found or received
reports of fraud, waste, and abuse related to legally
responsible individuals receiving compensation for providing
care.
MR. NEWMAN answered no; the department had not seen fraud,
waste, and abuse outside the norm. The caveat is that the
department doesn't know how widely this option has been used.
The department is researching that question now, so the details
will be forthcoming.
SENATOR GIESSEL said she'd appreciate the information.
3:45:59 PM
CHAIR WILSON if it was the homes or the caregivers that would
require licensure.
MR. NEWMAN replied that the home setting would need to be
licensed by the department and the caregiver would need to be
certified by the Division of Senior and Disability Services to
provide the adult home care service. He noted that the fiscal
notes reflect added staff to handle the additional licensing and
certifications.
CHAIR WILSON asked if the department envisions developing a new
type of license and a new type of certification.
3:47:25 PM
MR. NEWMAN replied that it would be a new type of certified
service that's informed by the existing types of certified
services.
CHAIR WILSON asked whether he was aware that Arizona recently
did away with the different types of licensure for caregiving
and created a single license type for multiple settings. This
recognizes that the difference between high certification and
low certification might be a matter of 40 hours of training. The
idea is to have a more unified caregiver workforce.
MR. NEWMAN replied he was not familiar with what Arizona had
done but the Division is always interested in ways to be more
efficient.
3:49:15 PM
At ease
3:49:26 PM
CHAIR WILSON reconvened the meeting and opened public testimony
on SB 57. He advised that written testimony could be submitted
to [email protected].
3:50:10 PM
STEPHANIE WHEELER, Long Term Care Ombudsman, Alaska Mental
Health Trust Authority, Department of Revenue, Anchorage,
Alaska, stated support for SB 57 which will offer seniors an
alternative to the existing service and living options. She said
her agency's mission is to provide resident-centered advocacy
that protects the rights, health, and safety of Alaskans who are
living in long-term care settings. When they visit care settings
it is common to hear seniors voice their preference to find an
assisted living home that is closer to the community where they
used to live or where they have family. SB 57 would offer
support for elders to remain in or near their community of
preference and her agency believes in offering seniors options.
She reiterated support for SB 57 and the choice it offers
seniors.
3:52:08 PM
PATRICK REINHART, Executive Director, Governor's Council on
Disability and Special Education ("Council"), Department of
Health (DOH), Anchorage, Alaska, reminded the committee that the
Council voiced support for SB 57 when they met with legislators
recently and nothing had changed. SB 57 is another tool to
provide services close to peoples' homes and in their
communities. He asked the committee to review the points in the
Council's position statement that they recently shared with
legislators. He opined that the costs reflected in the fiscal
note were minor compared to the potential savings to the state
by not relying so heavily on institutional care. He expressed
hope that the bill would pass.
3:53:44 PM
MARGE STONEKING, Advocacy Director, AARP Alaska, Anchorage,
Alaska, stated support for the continued expansion and
improvement of home and community-based waiver services to
support the rapidly growing senior population. This includes
offering a range of residential setting options because most
people want to remain in their own homes and communities as they
age. She said home and community-based services cost a fraction
of the cost of a nursing home, but the home care workforce
crisis combined with the rapidly aging population was
threatening access to home and community-based services (HCBS)
and driving people into assisted living or nursing homes. She
warned that this could increase the Medicaid rolls as few people
can afford long-term care in facilities such as nursing homes.
She said the Adult Care Home model offers another tool that can
appeal to both waiver participants and prospective workers. It
is a solution that AARP welcomes. SB 57 will reduce the
administrative burden for operators while offering seniors and
others the option of a more home-like setting with lower-level
services and fewer residents. It is important to support older
Alaskans in aging in place with a participant-directed care
service model. She said AARP supports SB 57 and looks forward to
working with the department on the required regulations.
3:56:24 PM
JOHN LEE, representing self, Palmer, Alaska, testified in
support of SB 57. He shared that as a former service provider in
some of the most rural Alaskan communities, he was well aware of
the challenges of offering services in these settings. The
difficult choice is to leave the community to live in an
assisted living facility, oftentimes in Anchorage, to have
access to needed services. He opined that SB 57 will go a long
way toward resolving this issue by providing care options closer
to home. The care will be provided in a more home-like setting
and potentially at a lower cost than an institution. He urged
the committee to pass SB 57.
3:58:54 PM
KIM CHAMPNEY, Executive Director, Alaska Association on
Developmental Disabilities (AADD), Juneau, Alaska, stated that
the 80 members of AADD are developmental disability service
providers and care coordinators who provide services statewide.
They support the option SB 57 offers. She said the developmental
disability vision states that services should support Alaskans
living the lives they choose to live. The focus is to build a
community-based system to meet the diverse needs of Alaskans.
She highlighted the current workforce shortage and the impact
this has on older Alaskans and people with disabilities. She
said flexibility is essential and the more flexibility the
system has, the better it will be in meeting the needs
throughout the state. She shared a personal experience to
emphasize the importance of providing flexibility for both
caregivers and people who need services. She also described the
impact that the rapidly growing senior population is having on
the developmental disability workforce. She said AADD looks
forward to working with its partners on the details if SB 57
passes.
4:02:22 PM
CHAIR WILSON closed public testimony on SB 57 and asked Mr.
Newman to talk about how a caregiver would be paid, who would
bill the state or Medicaid for the services, and how this
differs from assisted living home billings.
MR. NEWMAN replied that the first step would be for the Division
of Senior and Disabilities Services to work with the Office of
Rate Review (which establishes Medicaid rates for services) to
establish the rates for the services that would be offered. That
hasn't happened. Under the existing system, the service
providers bill Medicaid and file claims with the state to
receive payment.
CHAIR WILSON recalled that when the committee reviewed Medicaid
audits last year they found that assisted living homes had a lot
of billing errors. He noted that the committee asked the
department whether more technical assistance could be provided
because difficulties with billing had been the cause for several
homes closing over the years.
4:05:43 PM
MR. NEWMAN said one of the ideas behind SB 57 is to reduce the
administrative requirements to encourage as many people as
possible to choose this option.
CHAIR WILSON asked whether he or someone else from the
Department of Health was available to talk about the potential
to save money for the state if the bill were to pass.
MR. NEWMAN stated that a ballpark estimate is that the state
would avoid spending $427 million by providing care services to
people in a setting that provides a lower level of care than
nursing homes and care facilities. He acknowledged that it would
be more expensive for people who are making do with less care
than they need. The division weighed those factors and concluded
that the cost to the Medicaid budget would be offset by the
savings. That's why the bill doesn't have a fiscal note for the
Medicaid services budget.
4:08:57 PM
CHAIR WILSON held SB 57 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 57 Version A.PDF |
SHSS 3/2/2023 3:30:00 PM |
SB 57 |
| SB 57 Summary Version A.pdf |
SFIN 3/28/2023 9:00:00 AM SHSS 3/2/2023 3:30:00 PM |
SB 57 |
| SB 57 Sponsor Statement.pdf |
SFIN 3/28/2023 9:00:00 AM SHSS 3/2/2023 3:30:00 PM |
SB 57 |
| SB 57 Sectional Analysis Version A.pdf |
SFIN 3/28/2023 9:00:00 AM SHSS 3/2/2023 3:30:00 PM |
SB 57 |
| SB 57 Presentation 3.2.23.pdf |
SHSS 3/2/2023 3:30:00 PM |
SB 57 |
| SB 57 FN 1 - DOH HCS.pdf |
SHSS 3/2/2023 3:30:00 PM |
SB 57 |
| SB 57 FN 2-DOH-SDS.PDF |
SHSS 3/2/2023 3:30:00 PM |
SB 57 |