Legislature(2021 - 2022)DAVIS 106
05/13/2021 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB89 | |
| HB106 | |
| HB153 | |
| HB139 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 139 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 89 | TELECONFERENCED | |
| += | HB 153 | TELECONFERENCED | |
| += | HB 106 | TELECONFERENCED | |
SB 89-ASSISTED LIVING HOMES: HOUSE RULES
3:28:56 PM
CO-CHAIR SNYDER announced that the first order of business would
be CS FOR SENATE BILL NO. 89(FIN), "An Act relating to house
rules for assisted living homes."
CO-CHAIR SNYDER reminded members that this bill, by request of
the governor, is the companion bill to HB 103, which the
committee heard on 4/13/21 and for which public testimony was
taken. She further reminded members that the committee first
heard CSSB 89(FIN) on [5/4/21], at which time amendments were
offered and the bill was held over for further discussion and
the amendment deadline extended. She explained that after
Amendment 2 was adopted it became clear during testimony by Mr.
Craig Baxter that the amendment needed to be changed. She said
the amendment's sponsor, Representative Spohnholz, would
therefore like to withdraw Amendment 2 and offer a revised
version to be responsive to the needs of the Department of
Health and Social Services (DHSS). She invited Representative
Spohnholz to provide background information.
3:31:32 PM
REPRESENTATIVE SPOHNHOLZ stated that in working with Mr. Baxter
and Suzanne Cunningham [Department of Health and Social Services
(DHSS)], and Stephanie Wheeler, State Long Term Care Ombudsman,
it was decided to rescind action on Amendment 2 and adopt a new
amendment that is clearer and will not require as detailed of a
regulation package. Amendment 3, she continued, is therefore an
update to the three changes put into the bill at the request of
the long term care ombudsman [via adoption of Amendment 2],
which are updated Internet access, quality of care, and
protection against retaliation.
3:32:59 PM
The committee took an at-ease from 3:33 p.m. to 3:35 p.m.
3:35:29 PM
CO-CHAIR ZULKOSKY moved to rescind the adoption of Amendment 2
to CSSB 89(FIN). There being no objection, the adoption of
Amendment 2 was rescinded.
REPRESENTATIVE SPOHNHOLZ withdrew Amendment 2 to CSSB 89(FIN).
There being no objection, it was so ordered.
3:35:56 PM
REPRESENTATIVE SPOHNHOLZ moved to adopt Amendment 3 to CSSB
89(FIN), labeled 32-GS1675\B.1, Dunmire, 5/12/21, 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) having access to the Internet provided
by the home, subject to availability in the community,
and having a private device to access the Internet at
the resident's own expense"
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; in this
paragraph, "quality care" means care of a resident in
accordance with the resident's assisted living plan,
plan of care, personal preferences, and health care
providers' recommendations"
Page 3, following line 20:
Insert a new bill section to read:
"* Sec. 4. AS 47.33.990 is amended by adding new
paragraphs to read:
(20) "retaliation" means an adverse action
taken, or threatened, by an assisted living home or an
agent of an assisted living home against a resident in
response to a complaint made to, or about, the home."
CO-CHAIR ZULKOSKY objected for the purpose of discussion.
REPRESENTATIVE SPOHNHOLZ explained that Amendment 3 is the
[proposed] new compromise language from working with Mr. Baxter
and [Ms.] Wheeler, and that the language would continue to
provide protection from abuse and discrimination. She specified
that the language for updating the Internet access provision now
states, "having access to the Internet provided by the home,
subject to availability in the community, and having a private
device to access the Internet at the resident's own expense".
So, she explained, it is saying that the resident must provide
his or her own device and that to the extent Internet is
available in the community, the home should provide it.
Representative Spohnholz conveyed that the language for quality
care now states, "means care of a resident in accordance with
the resident's assisted living plan, plan of care, personal
preferences, and health care providers' recommendations". She
noted that this definition is consistent with the intent of a
home and community-based waiver services final rule, given the
purpose of the bill is to get Alaska in compliance with that.
Lastly, she said, Amendment 3 would add a definition to
retaliation under AS 47.33.990, which is not currently defined
in the assisted living homes chapter. This new language states
that retaliation "means an adverse action taken, or threatened,
by an assisted living home or an agent of an assisted living
home against a resident in response to a complaint made to, or
about, the home." She pointed out that this language is more
specific so that a perception of a threat does not qualify.
3:38:20 PM
REPRESENTATIVE KURKA said his concern is whether this language
would prohibit the home from expelling a resident who is hostile
and making it a bad experience for everyone.
REPRESENTATIVE SPOHNHOLZ replied that Amendment 3 is drafted in
a way so it would not create the scenario where assisted living
homes are forced to have hostile residents living there. She
deferred to DHSS to address the process for evicting someone who
is hostile.
3:40:26 PM
CRAIG BAXTER, Program Manager, Residential Licensing Section,
Division of Health Care Services, Department of Health and
Social Services (DHSS), responded that there are six different
reasons under which an assisted living home can evict a
resident, of which one is documented disruptive behavior that
puts the resident, staff, or other residents in the home at
risk. If the facility meets proof that the resident's behaviors
are putting others at risk, [the facility] can terminate its
contract with the resident. He said DHSS would not look at it
as retaliation if the resident involved was threatening others,
harming others, harming themselves, or harming staff.
3:41:15 PM
REPRESENTATIVE KURKA said he is concerned about the practicality
of the language in Amendment 3 regarding Internet availability
in the community. For example, he pointed out, Wasilla has good
Internet service in general but certain spots within the
community have poor service, which is the case for his business
location. He said it makes sense that the device for accessing
the Internet be at the resident's own expense, but he is
concerned about having the requirement as a right.
REPRESENTATIVE MCCARTY offered his belief that the amendment's
language, "subject to availability in the community," does
address the concern because it would fit the scenario of
availability in one spot in the community but no availability
across the street from that spot.
REPRESENTATIVE KURKA argued that the language is the same
community not a different community, and "community" is broader
than the language [in Amendment 2] which specifically stated
available to the "home". So, he maintained, if a certain level
of service is available in the community, the home would have to
provide that level of service even if the Internet provider was
unable to provide that same level of access to the home.
REPRESENTATIVE MCCARTY said he is not concerned with the use of
community nor the device being at the resident's own expense.
REPRESENTATIVE KURKA suggested a conceptual amendment that would
replace "in the community" with "to the home".
REPRESENTATIVE SPOHNHOLZ suggested "in the community to the
home,".
CO-CHAIR SNYDER suggested "availability to the home in the
community,".
3:46:33 PM
REPRESENTATIVE SPOHNHOLZ moved Conceptual Amendment 1 to
Amendment 3: after "availability" insert "to the home". Thus
page 1, line 11, would read, "subject to availability to the
home in the community, and having a private device to". There
being no objection, Conceptual Amendment 1 to Amendment 3 was
adopted.
3:47:56 PM
The committee took a brief at-ease.
3:48:34 PM
CO-CHAIR ZULKOSKY asked whether it is clear within this language
that there are exceptions for facilities located within
communities that don't have unencumbered access to the Internet.
MR. BAXTER responded that he believes the language as crafted
would cover DHSS for ensuring that exemptions could be carved
out for communities and individual facilities that have
difficulty accessing the Internet or high-speed Internet.
3:51:03 PM
REPRESENTATIVE KURKA noted the inequality of Internet pricing
across the state. He pointed out that the further away from
urban areas the higher the cost for the same level of service
costs. He said he is concerned about putting this cost burden
on the assisted living homes unless it is something the homes
already have. He said he is going to oppose Amendment 3 rather
than offer an amendment to shift this cost burden from the home
to the resident.
CO-CHAIR ZULKOSKY removed her objection to the motion to adopt
Amendment 3 [as amended] to CSSB 89(FIN).
REPRESENTATIVE KURKA objected to Amendment 3, as amended.
A roll call vote was taken. Representatives McCarty, Spohnholz,
Fields, Zulkosky, and Snyder voted in favor of Amendment 3, as
amended. Representatives Prax and Kurka voted against it.
Amendment 3, as amended, was therefore adopted by a vote of 5-2.
3:54:21 PM
REPRESENTATIVE KURKA moved to adopt Amendment 4 to CSSB 89(FIN),
labeled 32-GS1675\B.2, Dunmire, 5/13/21, which read:
Page 1, lines 4 - 5:
Delete ". The house rules must be consistent with
42 C.F.R. 441.301(c)(4) and [,]"
Insert ","
Page 1, line 6, following "chapter.":
Insert "An assisted living home that receives
federal funds shall adopt rules consistent with 42
C.F.R. 441.301(c)(4)."
Page 1, line 12, following "42 C.F.R.
441.301(c)(4)(vi)(D)":
Insert "if the provider receives federal funds"
CO-CHAIR SNYDER objected for the purpose of discussion.
REPRESENTATIVE KURKA spoke to Amendment 4. He allowed it is
important to protect residents in [assisted living] homes in
statute, but said he is concerned that the bill cites federal
laws and regulations that the homes must comply with. That is
appropriate for homes which are receiving federal funds, he
stated, but it would be unjust and inviting federal overreach to
require homes which do not receive federal funds to comply with
federal regulations. He said Amendment 4 would therefore limit
the scope of this to those homes that receive federal.
CO-CHAIR SNYDER requested Ms. Lynne Keilman-Cruz to speak to the
concern that Amendment 4 would address.
3:56:11 PM
LYNNE KEILMAN-CRUZ, Chief of Quality, Division of Seniors and
Disabilities, related that [DHSS] had considered that language
in the bill but didn't see how a system could be established
where private-pay individuals who could potentially pay more
would have less rights than those receiving support under the
Medicaid waivers. It would be a double standard, she stated, so
for consistency [DHSS] made it apply to all providers regardless
of the funding type. She said [DHSS] believes this is minimally
burdensome as currently written without Amendment 4 and there is
no indication that providers would not currently meet those
minimal standards. She further noted that there are very few
providers not receiving Medicaid or not certified Medicaid
providers, so the language in the bill is minimally burdensome
to the department.
MR. BAXTER agreed. He stated that if this right is going to be
afforded to residents in some assisted living homes it should be
afforded in all assisted living homes. For residents' rights,
he said, it must be remembered that these are the residents'
homes, not institutions, so this is something that should be
supported across all facilities, not as certain ones that are
dependent on Medicaid dollars. He said residents and their
families would find it difficult to comprehend if a resident was
to move from one home to another and the rules on their rights
suddenly change because that home doesn't accept Medicaid home
and community-based waiver service. He maintained that
residents should be afforded the right regardless of which
assisted living home they are residing in and should be able to
have visitors of their choosing at the time of their choice,
just as would anyone else living in their own personal home.
4:00:01 PM
REPRESENTATIVE PRAX said he doesn't understand how anybody would
be forced to live in any given home, so he questions why the
homes should be required to do something. If a person wants a
service that is not offered, he continued, then that person has
the right to not purchase that assisted living home.
CO-CHAIR SNYDER responded that sometimes by virtue of limited
availability a person's options are restricted, and therefore
someone requiring the services of an assisted living home is
forced into that option.
REPRESENTATIVE SPOHNHOLZ noted 42 CFR 441.301(c)(4) includes an
individual's rights to privacy, dignity, respect, and freedom
from coercion and restraint. She stated that folks should be
able to have the things listed here as rights regardless of
whether they are being paid for by the resident or by Medicaid.
These are people's homes, places where three or more people
live, she continued, and people should be able to live in
dignity and free from interference, so they have the liberty to
live their best lives.
REPRESENTATIVE PRAX concurred, but said the simple solution is
that someone can move if they don't like where they are living.
He said he questions how often people are forced to live in a
given home situation.
REPRESENTATIVE SPOHNHOLZ answered that these are people who
cannot live by themselves autonomously. She stated that in some
communities there may not be multiple assisted living homes and
therefore few choices. She further stated that at a little over
700 assisted living homes in Alaska there aren't enough to meet
the need and it is difficult to find a home. It needs to be
ensured that everybody can have the rights of dignity and
liberty, she said, regardless of how it is being paid for.
4:03:47 PM
REPRESENTATIVE KURKA stated that Amendment 4 would not change
the nearly three pages of statute that do guarantee the rights
of residents. He said his objection and the thrust of the
amendment is not that onerous things are being added to this
law, but that federal statute is being cited, which is subject
to change and not governed by the Alaska State Legislature. If
it is thought that those federal rules are good, he continued,
then they should be put into state statute instead of citing the
federal code number and saying a home must comply with federal
rules and state rules. There are two standards, he stated, and
the issue is saying that a home must comply with the federal
rules even if not receiving federal monies.
CO-CHAIR SNYDER stated she sees the logic, but noted it isn't
unusual to reference federal rules and regulations in Alaska
statute and therefore it isn't something that makes this unique
to some other aspects of Alaska's statutes. She said there is
opportunity moving forward if Representative Kurka wants to
pursue being more specific with state protections and
integrating that into state statute, but that it gives her pause
to remove these protections before being prepared to insert
state level protections.
CO-CHAIR ZULKOSKY asked whether she is correct in understanding
that the department's position is that adopting Amendment 4
could make enforcement of this legislation complicated and
potentially burdensome for DHSS.
MR. BAXTER replied that having two different standards would
make it difficult for DHSS to apply them and people would
struggle when trying to transition between the facility types
with different standards. He advised that having the same
standard across the board for all facilities and all residents
is ideal, especially since it is a resident's right.
4:08:35 PM
REPRESENTATIVE KURKA submitted that citing federal [law and
regulation] in Alaska statutes is part of the problem the
state is held by federal strings that may or may not be in the
best interest of the state and its communities. He said he
isn't saying there is anything objectionable in this specific
federal statute, rather he is objecting to applying federal
strings to [assisted living] homes that are not taking federal
money. Regarding the department's concerns about enforcement,
he argued that DHSS has two separate standards that are being
added here and it's not a matter that these rights are being
deprived but that new federal requirements are being referenced
in addition to the state's requirements. He said homes will
have to comply with nearly three pages of rights and regulations
and it's a matter of whether to comply with federal statute or
code when a home is not receiving federal money.
CO-CHAIR SNYDER maintained her objection.
A roll call vote was taken. Representative Kurka voted in favor
of Amendment 4. Representatives Fields, McCarty, Spohnholz,
Prax, Zulkosky, and Snyder voted against it. Therefore,
Amendment 4 failed to be adopted by a vote of 1-6.
4:11:35 PM
CO-CHAIR ZULKOSKY moved to report CSSB 89(FIN), as amended, out
of committee with individual recommendations and the
accompanying fiscal notes, and to give Legislative Legal
Services the authority to make technical and conforming changes.
4:12:09 PM
The committee took a brief at-ease.
4:12:42 PM
REPRESENTATIVE KURKA objected.
A roll call vote was taken. Representatives Spohnholz, Fields,
McCarty, Prax, Zulkosky, and Snyder voted in favor of moving
CSSB 89(FIN), as amended, out of committee. Representative
Kurka voted against it. Therefore, HCS CSSB 89 (HSS) was moved
out of the House Health and Social Services Standing Committee
by a vote of 6-1.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 139 House HSS Hearing Request Memo 3.20.2021.pdf |
HHSS 5/13/2021 3:00:00 PM |
HB 139 |
| HB 139 National Guardianship Association Standards of Practice 3.20.2021.pdf |
HHSS 5/13/2021 3:00:00 PM |
HB 139 |
| HB 139 Guardianship and End-of-Life Decision Making--Journal of the American Medical Association 3.20.2021.pdf |
HHSS 5/13/2021 3:00:00 PM |
HB 139 |
| HB 139 Sectional Summary 3.20.2021.pdf |
HHSS 5/13/2021 3:00:00 PM |
HB 139 |
| HB 139 Sponsor Statement 3.20.2021.pdf |
HHSS 5/13/2021 3:00:00 PM |
HB 139 |
| HB 139 Version I.PDF |
HHSS 5/13/2021 3:00:00 PM |
HB 139 |
| HB 153 FN- HSS.pdf |
HHSS 5/13/2021 3:00:00 PM |
HB 153 |
| HB 139 DOA FN.pdf |
HHSS 5/13/2021 3:00:00 PM |
HB 139 |
| HB 153a Invited Testimony for 20 April 2021.pdf |
HHSS 5/13/2021 3:00:00 PM |
HB 153 |
| HB0153A.PDF |
HHSS 4/20/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
HB 153 |
| HB153 - Sectional Analysis.pdf |
HHSS 4/20/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
HB 153 |
| HB153 - Sponsor Statement.pdf |
HHSS 4/20/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
HB 153 |
| HB 153 Supporting Documents and Education as of 04.19.2021.pdf |
HHSS 4/20/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
HB 153 |
| 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 Sectional Analysis Version GS 1675 A.pdf |
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 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 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 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 Letter of Support Colony Assisted Living Homes.pdf |
HHSS 5/13/2021 3:00:00 PM SHSS 4/1/2021 1:30:00 PM |
SB 89 |
| SB 89 Letter of Support Samash_Redacted.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SHSS 3/18/2021 1:30:00 PM |
SB 89 |
| SB 89 Settings Information webpage.pdf |
HHSS 5/13/2021 3:00:00 PM |
SB 89 |
| SB 89 Amendments.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
SB 89 |
| SB 89 Explanation of Changes ver. A to B 4.13.2021.pdf |
HHSS 4/29/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM SFIN 4/14/2021 9:00:00 AM |
SB 89 |
| SB 89 Amendments.pdf |
HHSS 5/4/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
SB 89 |
| HB 106 Sectional Analysis version A.pdf |
HHSS 5/13/2021 3:00:00 PM HSTA 3/11/2021 3:00:00 PM |
HB 106 |
| HB 106 Fiscal Note HSS PS.PDF |
HHSS 5/13/2021 3:00:00 PM HSTA 3/11/2021 3:00:00 PM |
HB 106 |
| HB 106 Fiscal Note DPS CJISP.PDF |
HHSS 5/13/2021 3:00:00 PM HSTA 3/11/2021 3:00:00 PM |
HB 106 |
| HB 106 DPS Prensentation 3.11.21 Distributed.pdf |
HHSS 5/13/2021 3:00:00 PM HSTA 3/11/2021 3:00:00 PM |
HB 106 |
| HB 106 Hearing Request 3.1.21.pdf |
HHSS 5/13/2021 3:00:00 PM HSTA 3/11/2021 3:00:00 PM |
HB 106 |
| HB 106 Sponsor Statement 2.18.21.pdf |
HHSS 5/13/2021 3:00:00 PM HSTA 3/11/2021 3:00:00 PM |
HB 106 |
| HB 106 version A.PDF |
HHSS 5/13/2021 3:00:00 PM HSTA 3/11/2021 3:00:00 PM |
HB 106 |
| HB 106 Additional Info - Missing Persons under 21 Statistics.pdf |
HHSS 5/13/2021 3:00:00 PM HSTA 3/16/2021 3:00:00 PM |
HB 106 |
| HB 106 Sectional Analysis 04.12.2021.pdf |
HHSS 4/22/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
HB 106 |
| HB 106 Sponsor Statement 04.12.2021.pdf |
HHSS 4/22/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
HB 106 |
| HHSS HB 106 DPS Presentation 04.12.2021.pdf |
HHSS 5/13/2021 3:00:00 PM |
HB 106 |
| HB 106 DPS Fiscal Note 04.12.2021.pdf |
HHSS 4/22/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
HB 106 |
| HB 106 HSS Fiscal Note 04.12.2021.pdf |
HHSS 4/22/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
HB 106 |
| HHSS HB 106 DPS Presentation 04.22.2021.pdf |
HHSS 4/22/2021 3:00:00 PM HHSS 5/13/2021 3:00:00 PM |
HB 106 |
| HB 139 Explanation of Changes, Version I to Version G 5.10.21.pdf |
HHSS 5/13/2021 3:00:00 PM |
HB 139 |
| HB 139 Blank CS Ver.G 5.10.21.pdf |
HHSS 5/13/2021 3:00:00 PM |
HB 139 |
| HB 139 Version G Sectional Summary 5.12.2021.pdf |
HHSS 5/13/2021 3:00:00 PM |
HB 139 |
| SB 89 Amendments, 5.13 .pdf |
HHSS 5/13/2021 3:00:00 PM |
SB 89 |