Legislature(2025 - 2026)BUTROVICH 205
02/13/2025 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation(s): Expanding Eligibility for Alaska's Infant Learning Program | |
| SB76 | |
| SB60 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 76 | TELECONFERENCED | |
| += | SB 60 | TELECONFERENCED | |
SB 76-COMPLEX CARE RESIDENTIAL HOMES 4:08:37 PM CHAIR DUNBAR announced the consideration of SENATE BILL NO. 76 "An Act relating to complex care residential homes; and providing for an effective date." 4:08:51 PM CHAIR DUNBAR opened public testimony on SB 76. 4:09:18 PM KIM CHAMPNEY, Executive Director, Alaska Association on Developmental Disabilities, Juneau, Alaska, testified in support of SB 76. She stated that their 109 member organizations provide home and community-based Medicaid waiver services to individuals with developmental disabilities across the state. She described a recurring cycle where individuals with complex behavioral needs lose service providers, often following an incident, and then cycle through hospitals or the Alaska Psychiatric Institute (API) until another provider is foundfrequently one with limited experience and inadequate resources. She emphasized that these unstable transitions are traumatic for both individuals receiving care, the direct support staff involved, and provider organizations. MS. CHAMPNEY expressed that the current system is not working and acknowledged the need for a different approach to service delivery. She affirmed AADD's support for SB 76, which she described as a step toward developing a new type of residential setting not currently available in Alaska. She added that AADD looks forward to working with the Departments of Health and Family and Community Services as service details are developed. 4:11:37 PM DAVID WALLACE, Chief Executive Officer, Matsu Regional Medical Center, Palmer, Alaska, testified in support of SB 76 and said he spoke on behalf of the 1,000 employees at Mat-Su Regional Medical Center. He described the case of a patient with dementia who had ten emergency room visits due to unmanaged behavioral health needs while residing at the Pioneer Home in Palmer. After being discharged from the Pioneer Home and spending 50 days in the emergency departmentdesigned for short-term carestaff experienced distress and frustration over the lack of appropriate placement options. MR. WALLACE explained that despite extensive collaboration among care teams, guardians, and state agencies, no suitable placement could be found for weeks due to the complexity of the patient's needs and limited licensed facilities. Eventually, a placement was secured in a home appropriately licensed and staffed, which he personally helped the patient transition into. He described the new setting as ideal and commended the care team. He urged support for SB 76, which he believes will help prevent similar situations and ensure proper care for individuals with complex needs. 4:16:27 PM JARED KOSIN, President, Alaska Hospital and Healthcare Association, Anchorage, Alaska, testified in support of SB 76 and described the legislation as a necessary step to address a chronic issue affecting Alaska's healthcare system. He reported that, based on monthly hospital surveys, an increasing number of patients remain in acute care settings despite no longer needing hospitalization. This is due to a lack of appropriate post-acute care placements. Patients are stuck in the most complex expensive environment in the healthcare system. The hospitals caring for them loose key resources without reimbursement. He noted that these patients occupy one out of every seven hospital beds in Alaska, resulting in over 43,500 additional hospital days in 2023 alone. He emphasized that a major reason for the created gridlock is the absence of services for individuals with complex needs. He stated that SB 76 would create complex care residential homes providing a more appropriate, lower-level care setting in communities, helping to ease hospital overcrowding and reduce unnecessary admissions. He urged the committee to pass the SB 76 as a critical first step in expanding access to care. 4:18:29 PM PHILLIP TAFS, representing self, Anchorage, Alaska, testified in support of SB 76. He said that as a consultant for the Complex Behavior Collaborative (CBC) for over a decade, he emphasized that creating a stable, well-trained complex care residential home system is the most impactful step Alaska can take to stabilize services for individuals with severe behavioral challenges. He described a revolving door pattern between hospitals, the Alaska Psychiatric Institute (API), out-of-state placements, and waiver-funded homes unequipped to handle such cases. He stated that this cycle is both financially costly and deeply harmful to individuals, leading to behavioral deterioration and reduced options for future transitions. He cited longstanding research, including the original Western Interstate Commission for Higher Education (WICHE) report, that has consistently identified this gap in the system. He also shared a recent tragic case of a young Alaskan who cycled through six to seven placements in one year due to lack of appropriate care and ultimately died, emphasizing that the cost and human toll of the current system far exceed the cost of building the right infrastructure. He strongly urged passage of the SB 76 to address this urgent and unmet need. 4:21:27 PM LUCY BAUER, Representative, Alaska Assisted Living Home Association, Anchorage, Alaska, testified in support of SB 76. She said she is a provider operating a large home in Anchorage for residents with mental health conditions since 1999. She described the challenges she regularly faces, including frequent crises and threats, and stated that while she loves her work and the people she serves, Alaska's mental health system is missing a critical piece. She expressed hope that SB 76 will serve as a vital bridge between hospitals and assisted living homes. She shared a tragic example of a 29-year-old man placed in the Department of Corrections (DOC). He required a higher level of care, but no facility would accept him, and five days later, he died in jail. She emphasized her 25 years of experience and stressed the urgent need for a proper system to support vulnerable adults. She thanked the Governor, the Department of Health, and others supporting the bill, expressing optimism for the positive changes SB 76 could bring. 4:23:54 PM JAMIE ELKHILL, Vice President, Youth and Transitional Age Youth (TAY) Services, Volunteers of America (VOA) Alaska, Eagle River, Alaska, testified in support of SB 76. She emphasized that complex care residential homes would provide a less restrictive, stable, and supportive environment for youth, young adults, and familiesreducing hospitalizations and out-of-state placements while keeping individuals close to their support systems. She shared that her organization, Volunteers of America Alaska (VOA Alaska), regularly sees the effects of this gap, including youth who relapse into substance use or self-destructive behavior due to unstable post-treatment living environments. She noted that during clinical reviews, 30 percent of youth ages 13 to 18 who completed treatment relapsed due to lack of support, with actual rates likely higher. She concluded that this legislation would not only improve individual outcomes but also reduce strain on other systems, such as hospitals, psychiatric facilities, the Office of Children's Services, and the criminal justice system. She urged the committee to support the SB 76, and other bills like it, stating it address a long-standing need that will help Alaskans with complex needs thrive in their communities. 4:27:57 PM MICHELLE OVERSTREET, Chief Executive Officer, My House, Wasilla, Alaska, testified in support of SB 76. She testified that Alaska faces a dire need for supportive housing for individuals with disabilities as they receive recovery services. She echoed the concerns shared by Mr. Wallace and Ms. Elkhill, emphasizing that this population needs structured support to heal and that the current gap in housing leads to continued trauma and risk, including death. She stated that while the proposed statutory changes may carry a cost, the savings from reduced reliance on crisis services and avoidance of additional harm would far outweigh them. She shared that her organization serves youth ages 14 to 24, many of whom are impacted by fetal alcohol spectrum disorders (FAS/FASD), attention deficit hyperactivity disorder (ADHD), traumatic brain injuries, and other behavioral health and medical conditions. A significant number are trauma survivors, including victims of incest, child rape, sexual assault, domestic violence, and neglect. She described a recurring pattern where clients cycle between emergency rooms, residential care, inpatient treatment, and correctional settings due to the lack of supportive housing at discharge. She gave the example of a current client, an incest survivor, staying at a shelter in Anchorage after spending three months in a behavioral health unit, with no suitable placement available. She stated that without housing support, this individual remains in danger and struggles to maintain services. She expressed strong support for SB 76, stating that the opportunity to establish this type of housing could help save lives. 4:30:27 PM CHAIR DUNBAR closed public testimony on SB 76. 4:31:20 PM EMILY RICCI, Deputy Commissioner, Department of Health (DOH), Juneau, Alaska, put herself on the record to answer questions on SB 60. 4:31:30 PM SENATOR HUGHES stated that the testimony provided made the need for SB 76 clear, particularly in light of the risks of placing individuals in inappropriate environments like jails or hospitals. She emphasized the severity of consequences, including the risk of death, when individuals with complex needs are not placed in proper care settings. She questioned whether the limit of 15 residents per home contained in SB 76 is appropriate, especially given the testimony about increasing need. While acknowledging that 15 residents may fill a large home, she raised the possibility of multiple homes sharing common areas, such as a courtyard, and asked if that would require a different licensing approach. She requested clarification on whether the 15-resident limit is based on research or regulatory constraints and whether a higher number could be considered if proper staffing ratios are maintained. 4:33:04 PM MS. RICCI explained that the limit of 15 residents is tied to a federal requirement related to Medicaid funding, specifically the "Institution for Mental Disease" (IMD) exclusion. This exclusion restricts how Medicaid dollars can be used for facilities with 16 or more beds that serve individuals with mental health conditions. She stated that to maintain eligibility for Medicaid funding, residential long-term care settings must remain under that 16-bed threshold. This constraint is why the bill proposes a cap of 15 residents. She added that other states with similar programs also commonly use this limit for the same reason, even though program models vary. 4:34:11 PM SENATOR HUGHES asked whether, under SB 76, multiple homes clustered on a shared courtyard would each require separate licenses, even if operated by a single business entity. She assumed this could be the case and requested clarification. She mentioned significant permitting delays for assisted living homes, acknowledging that while this is a new license type, similar issues could arise. She expressed hope that the licensing process for complex care residential homes would be more efficient and not take months to complete. She requested information on the expected processing time for licensure under SB 76 and confirmation that one business owner would be allowed to operate multiple licensed homes. 4:35:10 PM MS. RICCI responded that the specific licensure requirements for complex care residential homes, including whether multiple homes on a shared property can be operated by a single business, will be promulgate regulation. She noted that careful design and implementation will be necessary to ensure compliance with federal requirements. She explained that while SB 76 allows for homes with up to 15 beds, the Department anticipates tailoring bed capacity through regulation based on the population served. For example, smaller settings may be more appropriate for youth or individuals with severe needs. MS. RICCI said regarding concerns about licensing delays, she clarified that assisted living home licensure is handled by the Division of Health Care Services, which includes two sections for licensing: one for health facilities (e.g., hospitals) and another for residential licensing (e.g., assisted living homes). She acknowledged that residential licensing faced significant staffing shortages in FY24, with a vacancy rate between 29 and 31 percent. However, the Department has been working to fill positions and, as of three weeks ago, residential licensing had only one vacancy remaining. She said that while many team members are new and still in training, improvements are underway to speed up the licensing process. She added that SB 76, as written, considers the licensing of complex care residential homes to fall under the health facilities licensing and certification sectiondistinct from the residential licensing section that manages assisted living homes. 4:38:24 PM CHAIR DUNBAR held SB 76 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| GCDSE.ICC Presentation 2025 Senate HSS 02-13-2025.pdf |
SHSS 2/13/2025 3:30:00 PM |
GCDSE.ICC Presentation 2025 Senate HSS 02-13-2025 |
| CSS LOS HB73 and SB76 2-6-25 (v.2 corrected).pdf |
SHSS 2/13/2025 3:30:00 PM |
HB 73 SB 76 |
| SB 76 CPH Letter of Support 2.12.25.pdf |
SHSS 2/13/2025 3:30:00 PM |
SB 76 |
| SB 76 LoS Foundation Health Partners 2.6.25.pdf |
SHSS 2/6/2025 3:30:00 PM SHSS 2/13/2025 3:30:00 PM |
SB 76 |
| SB76 LOS VOA 2.11.25.pdf |
SHSS 2/13/2025 3:30:00 PM |
SB 76 |