Legislature(2021 - 2022)DAVIS 106
05/04/2021 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB65 | |
| SB89 | |
| HB105|| HB116 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 153 | TELECONFERENCED | |
| += | HB 106 | TELECONFERENCED | |
| += | HB 105 | TELECONFERENCED | |
| += | HB 116 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 65 | TELECONFERENCED | |
| + | SB 89 | TELECONFERENCED | |
SB 89-ASSISTED LIVING HOMES: HOUSE RULES
3:40:07 PM
CO-CHAIR SNYDER announced that the next order of business would
be CS FOR SENATE BILL NO. 89(FIN), "An Act relating to house
rules for assisted living homes." She noted that CSSB 89(FIN)
is the companion bill to HB 103, which the committee heard on
4/13/21.
3:40:54 PM
JOHN LEE, Director, Anchorage Office, Division of Senior and
Disabilities Services, Department of Health and Social Services
(DHSS), presented CSSB 89(FIN) on behalf of the House Rules
Committee by request of the governor. He spoke from a document
titled, "SB 89 Assisted Living Homes; House Rules ONE PAGE
SUMMARY." He stated that the bill is needed because Alaska's
statutes are not in compliance with federal regulations that
require home and community-based service providers to give
people who are on waivers the same access to the community as
people who are not on waivers. For example, state law allows
that an assisted living home may establish house rules that
address a resident's rights to have visitors.
MR. LEE pointed out that while state statute says the rules may
not be unusually restrictive, the federal regulation is more
explicit, stating that individuals on waivers and in such
settings "are able to have visitors of their choosing at any
time." Although Alaska received initial approval from the
federal government for its plan to bring its settings into
compliance, he advised, the approval was contingent on the state
revising its statute to reflect this federal statute. Ongoing
financial participation in the state's waiver programs by the
federal government is reliant on services being provided in
compliant settings. Without this amendment to the state statute
the federal government match is in jeopardy.
MR. LEE explained that the bill proposes a simple insertion of
language into the Assisted Living Homes Statutes [AS 47.33] that
will bring the state into compliance with the Centers for
Medicare and Medicaid Services (CMS) home and community-based
settings requirements, thereby protecting Alaska's federal share
of [Medicaid] payments for home and community-based [waiver]
services. The bill ensures that [recipients] of residential
[waiver] services will be able to live under conditions that are
as much like a person's home as possible.
MR. LEE addressed who would be impacted by the bill. He related
that Alaska's approximately 700 assisted living homes would be
required to abide by the conditions defined in the bill. The
new statutory language would afford all residents living in
assisted living homes the same rights, regardless of whether the
home accepts Medicaid as payment. Over 650 homes are already in
compliance with these conditions because they are certified to
operate home and community-based waiver services under these
conditions.
MR. LEE reviewed the timeline [for compliance]. He stated that
CMS requires states to have these settings in place by March
2023. He further noted that the fiscal impact is zero.
3:43:43 PM
MR. LEE provided a sectional analysis of CSSB 89(FIN). He
explained that Section 1 amends AS 47.33.060, House Rules for
Assisted Living Homes that Explicitly Require Consistency with
Federal Law When House Rules are Established. Section 2 adds a
new [subsection] for assisted living homes to make explicit that
assisted living homes that provide waiver services may not adopt
house rules inconsistent with federal law. Section 3 carries
the statutory amendments proposed in Section 1 and Section 2
regarding the resident's right to have visitors.
3:44:29 PM
CO-CHAIR ZULKOSKY asked whether there are any significant
changes between [CSSB 89(FIN)], the Senate version before the
committee, and HB 103, which the committee heard previously.
MR. LEE replied that one of the bills has language that
addresses the Executive Order (EO) to split the department into
two compartments, and the other does not. In further response
to Co-Chair Zulkosky, he confirmed that that is the only
significant change.
3:45:26 PM
REPRESENTATIVE KURKA asked which committee is the bill's next
referral.
CO-CHAIR SNYDER responded that there is no other committee of
referral, so the bill will next go to the House Rules Committee.
3:46:19 PM
REPRESENTATIVE MCCARTY moved to adopt Amendment 1 to CSSB
89(FIN), labeled 32-GH1675\A.2, Dunmire, 4/15/21, which read:
Page 1, lines 7 - 12:
Delete all material and insert:
"* Sec. 2. AS 47.33.060 is amended by adding new
subsections to read:
(e) An assisted living home shall permit an
individual immediate access to a resident without
requiring an appointment if the individual visits the
resident during the visiting hours established by the
home, subject to the resident's consent to receive a
visit from the individual.
(f) An assisted living home may adopt an appointment
system to facilitate visits outside of visiting
hours."
REPRESENTATIVE SPOHNHOLZ objected for purposes of discussion.
REPRESENTATIVE MCCARTY withdrew Amendment 1 so as to not cause
conflict with federal rules.
3:47:16 PM
REPRESENTATIVE SPOHNHOLZ moved to adopt Amendment 2 to CSSB
89(FIN), labeled 32-GH1675\A.4, Dunmire, 4/28/21, which read:
Page 2, line 1, following "environment":
Insert "free from abuse and discrimination"
Page 2, line 16:
Delete "and"
Insert "[AND]"
Page 2, line 18, following "AS 47.33.060":
Insert "; and
(D) reasonable access to the Internet, to
the extent available to the home;"
Page 3, line 5, following "with":
Insert "cultural preferences and"
Page 3, line 11, following "home":
Insert "without fear of reprisal or retaliation"
Page 3, line 18:
Delete "and"
Insert "[AND]"
Page 3, line 20, following "home":
Insert ";
(20) receive information in a language the
resident understands; and
(21) receive quality care"
CO-CHAIR ZULKOSKY objected for purposes of discussion.
REPRESENTATIVE SPOHNHOLZ explained Amendment 2 would incorporate
the following recommendations from Alaska's Office of Long Term
Care Ombudsman: that residents be free from abuse and
discrimination, that reasonable internet access be ensured to
the extent available, that strengthen the rights of residents to
submit grievances, that residents can receive cultural
preferences with regard to meal preparation along with religious
and other health related restrictions, that residents who aren't
English proficient receive information in a language they can
understand, and that residents can live in the home and file
complaints without fear of reprisal and retaliation. She said
these recommendations reflect grievances addressed by the
ombudsman related to assisted living homes. She drew attention
to a letter provided to committee members that the Long Term
Care Ombudsman submitted to the committee chair.
3:49:13 PM
REPRESENTATIVE PRAX expressed concern that these recommendations
are somewhat nebulous and subject to interpretation. It is up
to the ombudsman to determine these things, he opined, and it
goes without saying that it should be without fear of reprisal
or retaliation but saying it can open the door. People in this
situation can be obstreperous and the facility must be able to
exercise some control; if the facility goes too far then the
resident's remedy is to go to the ombudsman. It should be
worked out on a case-by-case basis rather than trying to spell
it out in statute.
REPRESENTATIVE SPOHNHOLZ offered her belief that these would not
be too nebulous or ambiguous. She said the average number of
residents in an assisted living home in Alaska is three, and
they are homes in communities, not large facilities. Although
people may need assisted living support, they should still be
able to continue having culturally appropriate foods, access to
the internet, and to feel safe in the home for which they are
paying for a service. The ombudsman can help the department in
the regulation drafting process for complying with the statute,
and that process would include an opportunity for public comment
and for operators of these homes to provide feedback.
3:53:26 PM
CO-CHAIR ZULKOSKY stated she would like to hear from the
department as to whether the preference is for broad language or
prescriptive language to capture the recommendations from the
Office of Long Term Care Ombudsman.
MR. LEE replied that [the Division of Senior and Disabilities
Services] has looked at Amendment 2 and does not believe it
would put the division at risk of violating the settings rules.
He deferred to Mr. Craig Baxter to answer the question from the
perspective of the Division of Health Care Services.
CO-CHAIR ZULKOSKY related that she has talked to some
constituent groups that run assisted living homes and they
welcomed the language in this amendment. She requested
confirmation that there would be regulation setting processes
that would provide assisted living facilities with the
opportunity to respond to this new statute.
MR. LEE deferred to Mr. Baxter to answer the question.
3:55:16 PM
CRAIG BAXTER, Assisted Living Home Manager, Residential
Licensing/Background Check Program, Division of Health Services,
Department of Health and Social Services (DHSS), on behalf of
the House Rules Committee by request of the governor, answered
that it depends on which one of the house rules the amendment
addresses. Some of them are fine and the division would be able
to enforce with the way the amendment is written; others are too
broad, and he would recommend the statute clarify some things
more clearly. His concern, he continued, is writing and
implementing a regulation package versus addressing it here
within the statute within the amendment, which would give a lot
more guidance on how to enforce. While he knows how the appeals
process goes and what the intent is, he can see [the department]
struggling to hold facilities accountable with some of the
items. The ombudsman's recommended amendments are great, but
some are broad enough that it might be difficult for [the
department] with the statute alone to provide quality
enforcement without there being a regulation package to clarify
and flush those out.
REPRESENTATIVE SPOHNHOLZ asked whether she is correct in
understanding Mr. Baxter to have said that a regulations package
would be needed to define more specifically the details for how
to implement Amendment 2.
MR. BAXTER replied yes. For example, he said, the "receive
quality care" amendment could be taken in many ways, so a
definition or flushing out within the amendment would give [the
department] some guidelines as to what the intent would be for
quality care. The food amendment is fine because the department
already has regulations that address food. Regarding the
"without fear of reprisal or retaliation" amendment, there are
already statutes that address retaliation, but more guidance is
needed on the word "fear." This is because someone could
interpret the actions of a facility in a way that they would be
afraid of reprisal when reprisal or retaliation weren't
intended. Must [the department] show that the facility intended
to take a reprisal or a retaliatory action against the
individual? [The department] would have to come up with a way
to define some of those items to be on solid footing for
enforcement. The proposed changes are positive and needed, but
more clarification would go a long way as far as providing
meaningful enforcement.
CO-CHAIR SNYDER remarked that she is hearing struggle back and
forth between desire to have statute that is prescriptive or
statute that is wide enough to give some latitude for
appropriate interpretation.
3:59:43 PM
REPRESENTATIVE KURKA commented that it looks like clarification
is being added on the list of what the rights are of the
residents of a home, but others are quite broad, and some seem
over the top. He questioned whether "reasonable access to the
Internet" is a right and whether it is a cost that should be
incurred by the home. He said he is concerned with adding more
and more things that are luxuries rather than basic needs.
REPRESENTATIVE SPOHNHOLZ related that "quality care" is included
in Amendment 2 because 374 complaints were received in 2020,
making it the second most frequent complaint for assisted living
homes that year. In 2019, 583 complaints were received, making
it a serious volume. She agreed the language in the amendment
is broad but said she prefers not to be too specific in statute
because the definition of "quality care" may change a bit over
time. The quality of care is a right that also aligns with the
home and community-based services final rule that focuses on
quality individual experiences. The long term care ombudsman
says that the quality of care should focus on a person-centered
approach to care, which is well defined because the report goes
into this in detail. She said she has been repeatedly assured
that the long term care ombudsman and [the Residential Licensing
Section] have a very robust working relationship. It is made
clear in the long term care ombudsman's report that residents
have the right to make choices and to control decisions in their
lives even in an assisted living home. Residents have the right
to provide input into their care plan and their care planning
team. She suggested the department work with the long term care
ombudsman to go into more granular detail regarding the
definition of quality care. Representative Spohnholz disagreed
that internet access is not a right. She argued that it is a
right because in 2021 a person who doesn't have access to the
internet lacks access to basic information and this is not less
important for people with disabilities or elders who need
physical support. Amendment 2 doesn't say how it would be paid
for, she added, but internet access should be a right in 2021.
CO-CHAIR ZULKOSKY removed her objection to Amendment 2.
REPRESENTATIVE KURKA objected to Amendment 2. He said he would
be more comfortable if the resident had the ability to incur the
extra cost of the internet and again questioned whether it is a
right to have access to the internet. He maintained that access
to food being selected on cultural preferences could be
extraordinarily broad and beyond convictions. He questioned
whether cultural preference should be considered a right and
said the menu should be looked at when a person is considering
which home to go into.
A roll call vote was taken. Representatives Spohnholz,
Zulkosky, and Snyder voted in favor of Amendment 2.
Representatives Prax and Kurka voted against it. Therefore,
Amendment 2 was adopted by a vote of 3-2.
4:07:23 PM
The committee took a brief at-ease at 4:07 p.m.
4:07:47 PM
CO-CHAIR SNYDER announced that CSSB 89(FIN) was held over.
REPRESENTATIVE KURKA noted that it was past the deadline for
submitting amendments to the bill.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 89 Amendments.pdf |
HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
SB 89 |
| SB 65 Amendment 1_Spohnholz.pdf |
HHSS 5/4/2021 3:00:00 PM |
SB 65 |
| SB 65 v. B.pdf |
HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM |
SB 65 |
| SB 65 Sponsor Statement 2.4.2021.pdf |
HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HJUD 5/5/2021 1:00:00 PM HJUD 5/17/2021 1:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 65 |
| SB 65 Sectional Analysis v. B 2.4.2021.pdf |
HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM SHSS 2/16/2021 1:30:00 PM |
SB 65 |
| CSSB65 Ver. I.PDF |
HHSS 4/27/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM SJUD 3/31/2021 1:30:00 PM |
SB 65 |
| SB 89 Version A.PDF |
HHSS 5/4/2021 3:00:00 PM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 FAQ on Final Rule prepared by Coalition for Community Choice.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 Fiscal Note 1 DHSS.PDF |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 One Page Summary.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SFIN 4/7/2021 9:00:00 AM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 All Ways Caring Letter of Support.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 FAQ on Final Rule prepared by Coalition for Community Choice.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM |
SB 89 |
| SB 89 Commission on Aging Letter of Support.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SHSS 4/1/2021 1:30:00 PM |
SB 89 |
| SB 89 Work Draft ver. B 4.13.2021.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/4/2021 3:00:00 PM SFIN 4/14/2021 9:00:00 AM |
SB 89 |
| CS for HB 105.pdf |
HHSS 5/4/2021 3:00:00 PM |
HB 105 |
| HB 105 Detention of Minors Sectional Analysis Version 32 GH1576 I.pdf |
HHSS 5/4/2021 3:00:00 PM |
HB 105 |
| HB 103, AKLTCO Annual Report.pdf |
HHSS 5/4/2021 3:00:00 PM |
HB 103 |