Legislature(1999 - 2000)
04/06/1999 06:04 PM Senate FIN
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE BILL NO. 58
"An Act establishing an in-home and community-based
services program for certain adults with long-term
care needs; and providing for an effective date."
This was the first hearing on this bill.
Senator Gary Wilken spoke to the bill. This was the second
of four bills containing recommendations made by the Long
Term Care Task Force. It was Recommendation #14 of the
report. It addressed those adults who wished to receive
long-term care in their home rather than an institution.
The bill belonged in the SFC because of the $425,000 fiscal
note, he continued. The costs would come from expansion of
the money provided for care to Alaskan's in need of long-
term care. This would cover long term care that was not
covered by Medicaid because it was not direct health care.
It was for services that would be given in-home such as
adult daycare, respite care, basic chore and homemaker
services, nutrition and transportation services (i.e. Meals
on Wheels), at-home skilled nursing and therapy care,
personal care, etc. These were levels of care that could
help those who were aging and had diminished capacity. If
they were helped on a regular basis, they would kept out of
the more expensive professional homes.
Senator Gary Wilken referred the members to written
testimony provided by Kay Burrows. Others were present and
willing to testify.
He stressed that it was an expensive bill but would save
money later on by keeping these adults out of institutions.
The Administration planned to recommend the committee
lessen the fiscal note because the bill also allowed for
access to federal funds in other services.
He had an amendment to offer.
Senator Al Adams had a question regarding the fiscal note.
He wanted to know if funding would be given to similar
health care programs that operated in rural areas. Senator
Gary Wilken did not know and deferred to the testifiers.
Alison Elgee returned to the table. She testified that the
bill addressed a gap in the present delivery of long-term
care services. The department did very well for people who
were fortunate enough to have the independent financial
resources to afford long-term care and for those people who
met the financial eligibility requirements of Medicaid.
What the department found was missing were services for the
people who were in between; those who had a moderate
income, those who had some needs that were not at the level
of care needs that warranted a nursing home environment.
Many people would be able to stay in their homes longer if
services could get to them earlier. There was advantage to
early prevention in terms of addressing long term care
needs. The longer those needs went unaddressed, the more
likely an individual would eventually require nursing home
levels of care.
She felt it was worth noting that the Legislation would
require participants to first draw on their own resources,
either third-party insurance payments or their personal
financial resources. However for many, that amount was
insufficient. For example, a home health nurse visit in
the Anchorage area cost $120 per visit. Many people could
remain at home if they had somebody coming to check on them
twice a week, but the cost of that would be over $1000 per
month. This was often beyond many people's personal
resources.
She stressed that while the bill added a new cost to the
state, the department believed it would provide a future
cost avoidance in terms of the kinds of costs the state
would be asked to carry for patients in institutional long-
term care.
Senator Al Adams repeated his question if rural health care
providers would be eligible for funds to provide the
services. Alison Elgee replied that the funds would follow
the client and there would be no provider excluded from
receiving it. Therefore, rural providers would be able to
receive compensation for services provided.
Senator Al Adams then asked about the proposed Amendment #1
that deleted coverage for sub-acute care. Alison Elgee
explained the amendment further defined the section that
addressed services that would not be covered by this
legislation. In the original bill, the services provided
that the program would not cover intermediate or skilled
care hospital services or services in the Pioneer Homes.
There was some feeling that it needed to include sub-acute
care, which was a different level of care than acute care
or nursing home care.
Senator Gary Wilken shared that Linda Fink was present to
specifically address this matter.
Co-Chair John Torgerson asked how the department would
define "moderate income". Alison Elgee responded that the
department would develop regulations to define eligibility.
The reason they did not try to define moderate from an
income perspective was because even an individual with a
monthly income of $2500 might not be able to afford the
$1000 services given their other financial circumstances.
The department would look at the cost for the package of
services necessary for the individual and then look at the
available income.
Co-Chair John Torgerson said that worried him. There was no
cap on the bill. He noted the growing percentage of the
senior population in Alaska. He guessed the fiscal note was
way understated.
Co-Chair John Torgerson asked for clarification of the
language on page 5 line 9 saying, "the department may waive
any requirement of this section if the department
determines that it is not cost effective to require
performance". He felt it was an exemption from the already
limited co-pay requirements. Alison Elgee replied that
sometimes it cost more to instigate collection than the
actual debt. This would allow the department to determine
when it was not worthwhile to pursue a collection. Co-
Chair John Torgerson countered that was not what the
language said.
Co-Chair John Torgerson said he would work with Senator
Gary Wilken to address the co-pay and income limits.
Alison Elgee pointed out that the bill specifically stated
that this was not an entitlement program and would be
limited to the funding appropriated by the Legislature.
Senator Gary Wilken misspoke earlier about the fiscal note.
It may be driven down considerably, not for federal money,
but the state would have access to foundation funds, such
as the Robert Wood Johnson Foundation. Kay Burrows would be
able to address later.
Senator Sean Parnell looked at the minutes from the Senate
Health and Social Services Committee. Senator Kim Elton
had asked her if the client base was being served in any
other way currently, or if these would be new clients. Her
response was that by spending some money now would save
more money in the long term. Senator Sean Parnell asked
her to quantify how that would be achieved. Alison Elgee
detailed the costs of nursing home care. By providing in-
home care now, more people would be kept out of the nursing
homes. She said that even for those who entered nursing
homes as paying clients, their assets were often depleted
and they ended up being cared for at the government's
expense. This program would offer these people support, not
force them to spend down all their assets and delay or
prevent their admittance into a nursing home. She noted
that the state was only reimbursed for only 60-percent of
the Medicaid costs.
Senator Sean Parnell understood that but wanted to know if
she had identified the pool of people this would apply to
and determine the number of people who would leave the
state if this service were not available. Was this a
complete new pool of people who would never become Medicaid
dependent? He could believe the argument that to spend
money now would save later, but he needed to see some
backup data.
Alison Elgee offered staff from the Department of Health
and Social Services who could better address those
concerns. From the Division of Senior Services, she could
tell him that the division had presently 587 older Alaskans
on the Medicaid waiver that would otherwise be eligible for
nursing home services at that average $12,500 per year
cost.
The department was trying to anticipate the increased needs
as a result of the growth of the senior population. There
had been a number of documents the committee had reviewed
that looked at the demographics of that population.
Presently, over 30,000 people in the state were over the
age of 65 and the department anticipated that figure would
more than double by the year 2015.
Senator Sean Parnell requested further clarification of the
savings. Presumably, this legislation was done in part
because the members felt it was the right thing to do and
in part because it was fiscally responsible. However, if
the committee was going to say that it saved money, it
ought to be identified how many patients would end up
costing money down the road. Otherwise he had the same
concerns as Co-Chair John Torgerson that this was open-
ended program. He continued sharing his desire to have the
savings detailed.
KATHY KLOSTER, daughter of deceased Alzheimer patient, and
Administrator, St. Ann's Care Center, testified. She spoke
of her father's experience. She said these in-home services
were important from a dignity standpoint.
As Administrator, she spoke of the changing roles of
nursing homes. In the past, patients came to the homes to
die. Now many were coming for treatment and care and then
return to society. There were two things mandated to
nursing home administrators. The first was to help
patients maintain their highest level of practicable
functions. If they could walk, it was the staff's
obligation to help them continue to walk. The second
mandate was to allow the patients to live in the least
restrictive environment. The responsibility for nursing
homes was to move patients out of the homes when possible.
They could do that if in-home based services were
available.
Senator Gary Wilken moved for adoption of Amendment #1,
saying it was a technical amendment dealing with acute and
sub-acute care. He requested Linda Fink come to table to
explain.
LINDA FINK, Assistant Director, Alaska State Hospital and
Nursing Home Association explained the amendment was to add
sub-acute care into the list of institutionalized care.
This was one other area that needed to be delineated.
Co-Chair John Torgerson asked what this did to the fiscal
note. Linda Fink said it did nothing and detailed it would
keep people out of the program that would need those kinds
of care.
Linda Fink added that the amendment also inserted "private"
so that there were no organizations left out.
Senator Sean Parnell wanted to understand where this fit
into the bill. Co-Chair John Torgerson asked if this was
intended to not provide payment for subacute care. Linda
Fink responded that was correct for this program.
Senator Sean Parnell asked where these services were
currently provided. Fink answered that they were covered
under Medicare. Senator Sean Parnell clarified that this
bill would not require the state to pay for sub acute care.
Amendment #1 was adopted without objection.
Co-Chair John Torgerson ordered the bill held in committee
to work on clarifying language and income limits.
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