Legislature(2025 - 2026)SENATE FINANCE 532
04/10/2025 09:00 AM Senate FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| HB69 | |
| SB57 | |
| SB76 | |
| SB44 | |
| SB69 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 44 | TELECONFERENCED | |
| + | SB 76 | TELECONFERENCED | |
| + | SB 69 | TELECONFERENCED | |
| += | HB 56 | TELECONFERENCED | |
| + | HB 69 | TELECONFERENCED | |
| += | SB 57 | TELECONFERENCED | |
SENATE BILL NO. 76
"An Act relating to complex care residential homes;
and providing for an effective date."
10:03:03 AM
EMILY RICCI, DEPUTY COMMISSIONER, DEPARTMENT OF HEALTH,
(DOH) introduced herself. She explained that the department
was working on the bill in close coordination with the
Department of Family and Community Services (DFCS).
DR. BOB LAWRENCE, CHIEF MEDICAL OFFICER, DEPARTMENT OF
HEALTH, discussed a presentation entitled State of Alaska,
Department of Health, Department of Family and Community
Services, SB 76: COMPLEX CARE RESIDENTIAL HOMES(copy on
file). He looked at slide 2, "SB 76 Supports Alaska's
System of Care
SB 76 strengthens Alaska's health care system,
enabling Alaskans to access services in settings
tailored to their specific care needs.
Dr. Lawrence addressed slide 3, "What Is Complex Care?
Definition: Co-occurring behavioral, medical, or
disability-related needs requiring a multi-
disciplinary team and multiple programs.
Vision: A coordinated system that delivers
compassionate, timely, and person-centered care for
the most vulnerable and complex Alaskans.
Dr. Lawrence pointed to slide 4, "What Is Complex Care?
Behavioral health conditions
Disruptive behaviors
Carceral system involvement
Out of state treatment
Psychiatric hospitalization
Public safety encounters
Co-occurring medical conditions
Frequent emergency department visits
Harm to self or others
Ms. Ricci discussed slide 5, "What Does SB 76 Do?
SB 76 creates the necessary statutory framework to
allow the Department of Health to license and regulate
a new setting:
Complex Care Residential Homes (CCRHs)
Ms. Ricci relayed that the department envisioned the new
setting to be homelike, based in the community, and with
multi-disciplinary support and consistent monitoring for
individuals.
10:07:51 AM
Ms. Ricci pointed to slide 6, "CCRHs Fill a Gap in the Care
Continuum
There is a gap in Alaska's current continuum of care
for ongoing, specialized residential settings.
Ms. Ricci drew attention to more acute settings listed on
the right-hand side of the slide, including psychiatric
hospitals or residential psychiatric treatment centers for
youth. The left-hand side of the slide showed less acute
settings for care, which relied on funding and support from
the department's Home and Community Based Waiver services.
She continued that there was a small group of individuals
with severe behavioral and medical needs. There may be some
cognitive impairment, but the level did not qualify them
for the waiver. For the individuals, she identified that
the system was struggling to find appropriate discharge
care, and a greater amount of care was needed than was
currently available in the system.
Senator Kiehl recalled that the previous year the
legislature passed a bill in which the department had
worked on creating a different category of home. He asked
how the new category fit into what she was describing.
Ms. Ricci replied that the new "Adult Host Homes" license
was created with statutory support the previous year and
would fit under the waiver between the assisted living
homes and complex care homes. Currently the individuals
supported in the bill did not meet the requirements for the
Home and Community Based Waiver system.
10:11:20 AM
Ms. Ricci looked at slide 7, "Establishing a New
Residential Setting
Identify Needs and Define Scope
Create New License Type
Determine Services to be Provided
Establish Reimbursement Mechanisms
Ms. Ricci identified that next steps would include working
with the people currently providing care for the
individuals in question.
Dr. Lawrence pointed to slide 8, "Who Would Benefit from
CCRHs?
Youth
Multiple behavioral health diagnoses
Treatment in an out-of-state facility
Adult
Severe and persistent mental illness
Frequent hospital visits and self harm history
Senior
Dementia with behavioral health diagnoses
Does not qualify for Medicaid waiver services
Fetal alcohol and autism spectrum disorders
Cognitive impairment
Highly disruptive behaviors
Dr. Lawrence looked at slide 9, "Key Features of a CCRH
CCRHs will offer a new residential care setting in
Alaska.
Fewer than 15 residents
24/7 care from a multi-disciplinary team
More supportive than assisted living homes and less
restrictive than a psychiatric hospital
Specialized monitoring, intervention, and/or treatment
to meet the needs of residents
Dr. Lawrence emphasized that the new care setting proposed
in the bill would be adaptable.
Dr. Lawrence spoke to slide 10, "Benefits of a CCRH
• Improves care for Alaskans with complex needs
• Adds a license type for home-like settings that
offer care in the most clinically appropriate
environment
• Allows for service specialization and for
specific requirements to be set forth in
regulations
• Promotes community safety by offering a new
service setting for individuals with complex
behavioral health needs
Dr. Lawrence qualified that the new care setting being
proposed would offer care beyond an assisted living home
but not so restricted in a hospital or psychiatric care
facility.
10:15:00 AM
Ms. Ricci discussed slide 11, "Sectional Analysis
Section 1. Amends AS 47.32.010(b) to add "complex care
residential homes" to the list of entities regulated
by the Department of Health.
Section 2. Amends AS 47.32.900(2) to update the
definition of "assisted living home" to exclude
complex care residential homes.
Section 3. Adds AS 47.32.900(11) to modify the
definition of "hospital" to clarify that it does not
include complex care residential homes.
Ms. Ricci pointed to slide 12, "Sectional Analysis
Section 4. Adds AS 47.32.900(22) to introduce a new
definition for "complex care residential home." It is
defined as a residential setting that provides 24-hour
multi-disciplinary care on a continuing basis for up
to 15 individuals with mental, behavioral, medical, or
disability-related needs requiring specialized care,
services and monitoring.
Section 5. Amends the 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 amendments to the state
Medicaid plan or apply for waivers necessary to
implement the provisions of Sections 1-4.
Ms. Ricci looked at slide 13, "Sectional Analysis
Section 6. Amends the uncodified law by adding a new
section specifying that sections 1-4 of the bill will
only take effect if the United States Department of
Health and Human Services approves the required
Medicaid waivers or amendments by July 1, 2031. The
commissioner of health is required to notify the
reviser of statutes within 30 days once the necessary
approvals are received.
Section 7. Provides that sections 1-4 take effect the
day after the United States Department of Health and
Human Services approves amendments to the state plan
or waivers submitted under Section 5.
Senator Kaufman looked at the fiscal notes and asked about
federal funds. He asked if there were any potential issues
with funding.
Ms. Ricci replied that the department did not anticipate
any issues but was still building out funding sources from
a Medicaid perspective. One of the aspects of the
populations that was particularly challenging was that
there were individuals with very specific needs and
specific demographics. She discussed a category of youth
with disruptive behaviors but did not qualify or
developmental or intellectual disability waivers. She
discussed a category of adults with severe eating
disorders, that were more extreme than was typically
imagined and needed specialized care in a structured
setting. She discussed adults with dementia that had
inappropriate behaviors that the Alask Pioneer Home and
others could not care for. For the groups, there could be
certain Medicaid waivers to cover the care that was needed.
She relayed that the department would be working with
consultants to identify the different Medicaid waivers and
funding streams that aligned with each of the needs.
10:19:08 AM
Senator Kaufman asked if there was anticipation of getting
more clarity on funding streams that might be reflected in
revised fiscal notes.
Ms. Ricci relayed that the current available information
the department had was reflected in the fiscal notes. She
noted that the department intended to build out the
certification, funding, and services with providers,
stakeholders, and contractual experts.
Senator Kiehl asked about the zero Medicaid services fiscal
note. He asked if the department anticipated that the note
would really be indeterminate.
Ms. Ricci relayed that the fiscal note was zero because
many of the individuals in question were receiving very
high-cost care that was paid for through the Medicaid
program. She added that also any waivers the state would be
considering there was a federal budget neutrality
requirement. For those reasons the department thought the
fiscal note would be zero.
10:21:19 AM
Co-Chair Hoffman OPENED public testimony.
10:21:38 AM
MICHELLE BAKER, EXECUTIVE VICE PRESIDENT, SOUTHCENTRAL
FOUNDATION, ANCHORAGE (via teleconference), testified in
support of the legislation. She worked in the behavioral
services division. She mentioned adults and children
awaiting to be discharged from the hospital without
residential services with complex care services. She gave
examples of individuals that needed complex care that was
not currently available. She recommended an amendment to
the bill and referenced Section 4, line 10, and removing
"not more than 15." She reasoned that removing the language
would give providers more flexibility to think about
clinical service delivery models.
10:25:52 AM
DAVID WILSON, DIRECTOR OF PUBLIC POLICY, MATSU HEALTH
FOUNDATION, WASILLA (via teleconference), spoke in support
of the legislation. He thought the bill was a vital step in
providing required care. He thought the bill would set a
standard for excellence in care. He echoed the comments of
the previous testifier regarding amended language in the
bill.
10:27:52 AM
JARED KOSIN, PRESIDENT AND CHIEF EXECUTIVE OFFICER, ALASKA
HOSPITAL AND HEALTHCARE ASSOCIATION, ANCHORAGE (via
teleconference), testified in support of the bill. He cited
that one out of every seven hospital beds in the state was
occupied by individuals that needed to go but had no option
for appropriate care to transition to. He urged the passage
of the bill.
10:29:00 AM
ISAAC SMOLDON, COMMUNICATIONS DIRECTOR, MY HOUSE, WASILLA
(via teleconference), spoke in support of the legislation.
He believed the legislation would allow My House to better
serve its clients. He urged the committee to pass the bill
as soon as possible.
Co-Chair Hoffman CLOSED public testimony.
Senator Kiehl reviewed the fiscal notes. He addressed FN 1
from DOH, OMB Component 2665. He detailed that an FY 26
cost of $153,200 and one full-time position with an even
funding split between federal receipts and General Fund
(GF) match. The amount leveled off at $150,200 with the
same funding composition.
Senator Kiehl addressed FN 2 from DOH, OMB Component 2944.
The note reflected a first cost in FY 27 of $197,100 split
almost 50/50 between federal receipts and GF match for one
full-time nurse consultant position. The amount leveled off
the following year slightly higher with $204,100 going
forward.
Senator Kiehl addressed FN 3 from DOH Medicaid Services,
OMB Component 3234, which had zero fiscal impact.
Dr. Lawrence thanked the committee.
Ms. Ricci thanked the committee.
SB 76 was HEARD and HELD in committee for further
consideration.
10:32:17 AM
AT EASE
10:35:27 AM
RECONVENED