Legislature(2021 - 2022)DAVIS 106
05/03/2022 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB98 | |
| SB132 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 98 | TELECONFERENCED | |
| += | SB 132 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 98-ADULT HOME CARE; ADULT ADOPTION
3:10:32 PM
CO-CHAIR ZULKOSKY announced that the first order of business
would be SENATE BILL NO. 98, "An Act relating to medical
assistance for recipients of adult foster care services;
establishing an adult foster care home license and procedures;
and providing for the transition of individuals from foster care
to adult foster care homes." [Before the committee was CSSB
98(FIN), reported out of the Senate Finance Committee on April
12, 2022.]
3:11:09 PM
JOHN LEE, Director, Division of Senior and Disabilities
Services, Department of Health and Social Services (DHSS), on
behalf of the bill sponsor, Senate Rules by request of the
governor, explained the changes to CSSB 98(FIN) made by the
Senate Finance Committee. He stated that the bill was amended
to widen its reach and strengthen the home- and community-based
support for Alaska's vulnerable populations. He said that the
changes were inspired by one central idea - whether adult foster
care services could be extended to more people than just those
aging out of the foster care system. When this question was
asked to stakeholders, he reported, the response was "an
enthusiastic 'yes.'" He explained that the change would mean
more opportunities for community-based care, create options less
expensive than group homes, have less demanding staffing
requirements, and allow care to be provided in a home-like
setting. He added that the intention would be to have the
regulations mirror child foster parent and home expectations.
He stated that these changes would allow more seniors to receive
care within their communities instead of having to move to urban
areas where senior living facilities were more available. He
posited that there could also be an economic benefit. He said
that there would be some additional staff required for
monitoring this new type of care setting, but otherwise
providing the service would be cost neutral to the state.
CO-CHAIR ZULKOSKY asked for a review of the sectional analysis.
3:14:32 PM
TONY NEWMAN, Deputy Director, Division of Senior and Disability
Services, Department of Health and Social Services, on behalf of
the bill sponsor, Senate Rules by request of the governor, gave
the sectional analysis for CSSB 98(FIN) [included in the
committee packet], which read as follows [original punctuation
provided]:
Section 1: Amends AS 25.23, Who May Adopt, to allow
for the adoption of an adult by only one member of a
married couple as long as the spouse consents to the
adoption.
Section 2: Adds a new section to AS 47.07, Medicaid
Assistance for Needy Persons, to create a new program-
adult home care services for individuals. Adult home
care services will be available for individuals at
least 18 years of age or older who are enrolled in a
home and community-base[d] waiver. The Department of
Health will develop regulations establishing the
standards and rates of the program and providing an
efficient process to allow existing foster homes to
transition into the new adult home care license.
Section 3: Amends AS 47.32.010(b) to add a new
setting, "adult home care homes," that shall be
subject to the centralized licensing functions of the
Department of Health.
Section 4: Adds a new section to AS 47.32 that defines
the conditions under which the department may license
an adult home care home. A person may be licensed to
operate such a home for up to two persons age[d] 18 or
older who are enrolled in home and community-based
waiver services. This section requires the department
to streamline the application process necessary for
the person to be approved as an adult home care home
provider and requires that the department approve
variances of building code requirements to the extent
permitted by state, local, or federal law.
Section 5: Amends 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 an amendment to the state
medical assistance plan, waivers, or an 1115
demonstration waiver as necessary to allow eligible
individuals to receive adult come care services and
other long-term care services that are not
duplicative.
Section 6: Amends uncodified law adding a new section
related to the conditional effect of section 4 and the
required state plan amendments submitted to the United
States Department of Health and Social Services.
Requires the department to notify the revisor of
statutes of the approval of state plan amendments.
Section 7: Effective date related to the requirement
for the department to provide notification of the
revisor of statutes of approval of state plan
amendments.
Section 8: Provides for a July 1, 2022 effective date
to align with the effective date of Executive Order
121 and the change of the applicable department to the
Department of Health.
3:17:33 PM
REPRESENTATIVE FIELDS referred to language on page 4 of the bill
which would require DHSS to give instruction to adult foster-
care applicants on acquiring a variance for their application if
their home does not meet building code requirements. He posited
that the new setting envisioned in CSSB 98(FIN) would include
family homes and asked why the department would advise a
variance rather than requiring the applicant to improve the home
to meet safety standards.
3:18:19 PM
CRAIG BAXTER, Program Manager, Residential Life, Division of
Health Care Services, Department of Health and Social Services,
explained that meeting many of the building codes for
traditional care facilities would require changes which could be
cost prohibitive for families providing the care, such as
installing a sprinkler system. He stated that the new setting
would be residential homes and voiced the understanding that
there are no codes currently in effect for residential care in
these new facilities. However, if building codes change in the
future, he explained that this provision of the bill would allow
DHSS to direct adult foster-care applicants to obtain a
variance; this is included to showcase the department's
willingness to help applicants go through the process if needed.
He reiterated that current residential-care building codes
require more updates only if the household is caring for three
or more people; therefore, most of the people targeted by this
bill would not be asked to comply.
REPRESENTATIVE FIELDS asked how many people per home the bill
would address.
MR. BAXTER explained that CSSB 98(FIN) would create a new
license for homes providing care for two or fewer individuals,
in comparison to facilities which care for three or more. He
explained that current building codes effect only home care
settings serving three or more people.
REPRESENTATIVE FIELDS expressed the understanding that fire
codes would not be an issue for the new applicants.
3:21:44 PM
REPRESENTATIVE MCCARTY noted that the proposed bill would limit
each home providing adult home care services to two or fewer
individuals. He questioned the inclusion of language which
would allow this number to be increased at the discretion of
DHSS.
MR. LEE replied that the intent is for two or fewer and
explained that there are possible scenarios where the state
would want to grant an exception. He stated that being able to
keep families together is the intent behind this language.
REPRESENTATIVE MCCARTY questioned the frequency of multiple
family members with adult foster care needs who would request
waivers.
MR. LEE explained that it is not common but does occur, and he
referred to a current case where three family members are being
served on waivers.
REPRESENTATIVE MCCARTY expressed the belief that the language
which would address this is "wide open" and questioned whether
it should be fine-tuned to be more specific to family-based
exceptions.
MR. LEE explained that the regulations would be made to manage
exceptions.
3:24:45 PM
REPRESENTATIVE SPOHNHOLZ shared her experience with having her
own home licensed for foster care and explained the coding
requirements. She expressed concern that treating adult foster
care homes as a subset of assisted living homes could introduce
a building code work-around for assisted living homes. She
asked why the adult foster-care licensing process is not being
conducted the same way as child foster care licensing.
3:26:18 PM
MR. BAXTER explained that for adult care facilities, local and
state fire codes would not differentiate between the type of
residence, rather the consideration would be the number of
adults being served. He stated that municipalities enforce
these codes based on the thresholds within the code and not on
how the service is labeled. He restated that the intent is for
DHSS to assist applicants who exceed the code thresholds, as
there are currently no fire codes within Alaska which require
the installation of a sprinkler system for homes serving two or
fewer adults.
REPRESENTATIVE SPOHNHOLZ noted that the proposed bill would
allow the licensing of adult foster care homes as foster care,
but they would be treated as assisted living homes. She asked
whether a new standard could be created for adult foster homes
to differentiate them from assisted living homes. She explained
that if the bill is truly "creating a whole new category" of
licensing for adult foster care, then the license should not be
subject to standards for a different type of care. She
suggested that the language of the bill be "tidied up" to
prevent the mixing of regulations.
3:29:47 PM
MR. NEWMAN explained that the intent of the bill is to "thread
the needle" to create a setting between foster care and assisted
living, and this aligns with the needs of stakeholders. He
explained that the language would be a safety net to allow
variances if needed later.
REPRESENTATIVE SPOHNHOLZ suggested that she may draft an
amendment to specify when variances could be made to increase
the limit of adults.
3:30:44 PM
REPRESENTATIVE FIELDS expressed opposition to including
variances, citing the possibility of a single caregiver being
unable to manage three adults with disabilities in the event of
an emergency like a fire. He argued that the department should
not be encouraging variances, and the language should be
stricken from the bill entirely. He continued that, if the
proposed legislation does not pass, those affected may not
receive appropriate care. He pointed out the difference between
staying at home or moving into an assisted living facility.
MR. LEE confirmed that most of the individuals affected would be
served with in-home support or with assisted living, and the
intent of the bill is to create a new option. He clarified that
the intent is not to divert clients from other options, but
instead to lower the barriers of providing care to create more
options across the state and increase access to care in places
where it would not otherwise exist. He shared that stakeholder
feedback supported creating another choice, as this would be
valuable for those wanting to remain in their communities or not
wanting to live in a group home.
REPRESENTATIVE FIELDS pointed to the higher cost associated with
the proposed setting as compared to receiving services through a
personal care attendant (PCA) and inquired about the differences
in workload between the two options.
MR. LEE explained that there are many ways in which people can
receive care and services from the state; however, this depends
on the individual's condition, and CSSB 98(FIN) would open
"certain avenues of support" for individuals to receive these
services. He deferred to Mr. Newman for further detail.
3:35:04 PM
MR. NEWMAN confirmed that the department's vision for the new
adult home care license is to target the needs of patients,
specifically the elderly, who are just starting to need at-home
assistance a few hours a week. He explained that, under current
practice, those people can receive services only within an
assisted living setting, and he posited that the proposed bill
would allow these people to continue living in a family home
setting and receive services, even as the services increase over
time. He described the proposed setting as a place one could
"stop at during the journey of your life."
REPRESENTATIVE FIELDS questioned the stakeholder input and
whether the money allocated through the new setting would be
enough to provide proper care.
MR. LEE explained that the reimbursement rate for adult home
care would need to be established and, because each person
requires a different level of service, the plans are "person-
centered," with the cost depending on the individual. He noted
that the costs spoken about during the presentation were all
example figures; the actual costs would vary based on each
person's needs.
3:37:16 PM
REPRESENTATIVE SPOHNHOLZ posited that the creation of the adult
home care setting could function as a workaround to assisted
living care by allowing compensation for similar care at a lower
rate.
MR. LEE reiterated that the goal is to create a care option
which is less restrictive and easier to procure licensure. He
pointed out that other states with similar policies have proven
to have valuable and viable care settings. He explained that a
new setting type must be established for the new license type to
be created.
MR. NEWMAN added that the main difference between the proposed
setting type and an assisted living home is the habilitation
requirements associated with the medical plan model of assisted
living facilities. He reported that many stakeholders have
expressed the desire to have a care option without habilitation
goals. He explained that the new setting for an adult home care
license would allow for service delivery without the
habilitation goals.
3:39:55 PM
REPRESENTATIVE MCCARTY reiterated the understanding that some
minors in foster care "age out" but still require care for a
mental or physical disability, and the proposed legislation
would allow them to stay with the foster family, with whom they
have a relationship, and continue to receive services. After
listening to testimony, he expressed the understanding that the
bill would be focused on allowing elderly people to move into a
home care situation without a prior relationship with their
caregiver, and this would allow other licensed facilities to be
bypassed. He questioned the situation the bill would be
addressing.
MR. LEE explained that the bill started with a focus on those
aging out of foster care; however, after hearing from
stakeholders and community members, it was rewritten to be
inclusive of other care recipients.
REPRESENTATIVE MCCARTY asked whether the new category in this
bill would allow for an elderly person to move in with an
extended family member [who gets the new license type] and have
the state pay for the services.
MR. LEE replied that the intent of the bill is to allow people
to choose a setting which best fits their needs. He explained
that people who have the space within their home and the desire
to provide services would be allowed to apply for the license,
and this would become an option for people receiving care. He
provided the scenario where an elderly person wished to remain
in his/her current home with a family member, who already
resided in the home. This family member would need the required
license to give the needed care. He pointed out that this
scenario would need to be addressed through regulation, as it
was not the original intention of the bill.
REPRESENTATIVE MCCARTY referenced the service waivers for people
with developmental disabilities and shared his concern that the
pool of eligible recipients would be widened too much by the
proposed legislation. He sought clarification on who would be
eligible to receive services.
MR. LEE explained that in order to receive services in the
proposed setting, an individual would have to already be on a
waiver.
3:45:25 PM
REPRESENTATIVE SPOHNHOLZ recollected that, for individuals who
need care past the age of 18, the House companion bill of CSSB
98(FIN) would only allow for the continuation of foster-care
services with the same family. She voiced support for the
House's version of the legislation. She shared her appreciation
of the intent to move away from the medical model of care for
people with intrinsic disabilities or needs which will never "go
away;" however, she voiced concern that the senior and
disabilities services waiver qualification would be mixing two
disparate groups. She suggested that expanding a bill intended
for extending foster care to also include senior care within a
new setting could lead to the creation of substandard assisted
living homes. She expressed discomfort in mixing foster care
and assisted living policy because they are two different levels
of service which are treated differently in eligibility
determination and licensing standards. She opined that the new
setting and licensure pathway the bill proposes is not the same
as a continuation of a family-like living model. She expressed
opposition to mixing the two.
MR. LEE referenced other states' plans which have created more
options for the aging population. These plans, along with
listening to feedback from stakeholders, informed the decision
to create a new service type for the benefit of older Alaskans.
He reiterated that the proposed setting would allow for more
care opportunities in rural areas where establishing assisted
living facilities would be much harder.
REPRESENTATIVE SPOHNHOLZ asked how eligibility and access would
be determined for the new setting and how this would be
different from the existing waiver system. She expressed the
opinion that there is more demand for [waiver] services than the
state can meet. She questioned whether the proposed legislation
would increase the demand for services and whether the criteria
for waiver eligibility would be changed.
MR. LEE explained that new regulations would need to be put into
place, but that the eligibility criteria would not change. He
stated that, once a person has been determined eligible, the new
setting would be an additional option for receiving services.
3:51:24 PM
REPRESENTATIVE PRAX referred to a list of levels of available
care examples in the summary of CSSB 98(FIN) provided to the
committee, which read as follows [original punctuation
provided]:
• Live at home and receive personal care services and
waiver services. Daily Cost - $284
• Live in an Assisted Living Home and receive Group
Home Services and other waiver services. Daily Cost -
$416
Live in a Nursing Home and receive no waiver
services. Daily Cost - $771
REPRESENTATIVE PRAX asked whether the level of care for the
proposed setting would be between the levels detailed in the
first and second bullets.
MR. LEE responded in the affirmative.
3:52:11 PM
CO-CHAIR ZULKOSKY opened public testimony on SB 98.
3:52:38 PM
STEPHANIE WHEELER, Long-Term Care Ombudsman, Department of
Revenue, expressed support for SB 98. She explained that the
proposed legislation would give seniors alternatives to the
existing services and living environments. As part of her work
ensuring quality care for Alaska's seniors, she explained that
she conducts unannounced visits to assisted living facilities.
She reported that many elders within these facilities express
the desire to receive care closer to their communities and
families. She opined that SB 98 would help elders meet their
care needs in the community of their preference.
3:54:05 PM
MICHELE GIRAULT, Executive Director, Hope Community Resources,
testified in favor of the concept of SB 98, citing a need for
greater flexibility for providers of youth with intellectual and
developmental disabilities. She reported that many families
currently providing foster care to children with disabilities
have resisted transitioning to an adult assisted living license
because of the complexities and additional facility needs
associated with this licensure. This has caused individuals
with disabilities to be removed from the care of families, with
whom they have formed relationships. The individuals are then
placed in assisted living facilities, even though they often
need youth transition support well into their twenties. She
acknowledged some of the complications of the new service
setting but opined that the proposed legislation would simplify
the transition process for young adults with disabilities,
allowing them a continued sense of normalcy and sense of family,
and she reiterated support for SB 98.
3:56:11 PM
LIZETTE STIEHR, Executive Director, Alaska Association on
Developmental Disabilities (AADD), testifying on SB 98,
explained that the AADD is the trade association for care
providers who work with individuals with intellectual and
developmental disabilities and expressed that AADD is "thrilled"
by the proposed addition of a new service setting. She
expressed the opinion that adding more options for service
settings would allow recipients to live "meaningful" lives with
more choices. She spoke about the complexity of the regulations
concerning assisted living homes and stated that this has been a
barrier to families providing care. She continued that the
adult foster care license would be beneficial to many people
within the system. She explained that the bill would provide
broader options and lower costs for care. She posited that many
of the questions brought up by the committee would be answered
through regulation.
3:58:26 PM
CO-CHAIR ZULKOSKY, after ascertaining that there was no one else
who wished to testify, closed public testimony on SB 98.
3:58:34 PM
CO-CHAIR ZULKOSKY announced that SB 98 was held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 98 Sectional Analysis Version GS 1708 W (4-19-22).pdf |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB 98-4-2-041522-DHS-N.PDF |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB 98-5-2-041522-DHS-Y.PDF |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB 98-6-2-041522-DHS-Y.PDF |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB 98 - ver. B.PDF |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB98 Summary of Changes v.W (4-29-22).pdf |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |
| SB98 Summary (May 2, 2022).pdf |
HHSS 5/3/2022 3:00:00 PM |
SB 98 |