Legislature(2005 - 2006)
05/10/2005 08:39 AM Joint 125
| Audio | Topic |
|---|---|
| Start | |
| SB125 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 125-LICENSING MEDICAL OR CARE FACILITIES
CHAIR DYSON said that the House adopted some amendments to the
original bill that are a valuable step toward resolving the
disagreement between the House and the Senate. He moved to adopt
HCS CSSB 125(FIN) am H, version S.A, as the committee's working
document.
REPRESENTATIVE GARA asked if that is the version that passed the
House.
CHAIR DYSON replied yes. There were no objections and HCS CSSB
125(FIN) am H, version S.A was adopted.
SENATOR DAVIS said that some amendments were approved and not
approved by the Department of Health and Social Services (DHSS)
and she wanted a representative from the DHSS to explain why
they disagreed on some amendments.
8:46:38 AM
DR. RICHARD MANDSAGER, Director, Division of Public Health,
explained that the House Finance Committee amendments limited
background checks for people and added a requirement to exclude
information that was not germane on a registry.
STEVE ASHMAN, Director, Division of Senior and Disabilities
Services, Department of Health and Social Services (DHSS), said
reversing senior services funds was unacceptable. The department
agreed to restore funding to clients with 300 percent of poverty
income if the money was used as a contribution towards cost of
care.
REPRESENTATIVE GARA said he aggress with the compromise with one
exception. He wanted the department to promise him that if
assisted living homes are right and the transfer of funds is not
legal and Medicaid comes after them for the money, the state
will cover them.
MR. ASHMAN responded that a Department of Law opinion says the
amendment meets legal standards.
REPRESENTATIVE GARA replied that he has no doubt that it is a
sound legal opinion, but he still had concerns.
STACIE KRALY, Civil Division, Department of Law, said that
auditors would use the guidelines for assisted living homes to
determine how those funds would be addressed. She indicated that
those costs cannot come back to the state.
8:54:05 AM
REPRESENTATIVE MCGUIRE said she is concerned that putting an
assurance on paper is red-flagging a potential concern.
MS. KRALY agreed and said that was an astute observation.
REPRESENTATIVE GARA said that he feels his question has not been
answered. It seems to him that if the state is telling assisted
living homes what they are doing is legal, it should be able to
say it will cover them.
MR. ASHMAN responded that the state would cover them if they
acted on its legal opinion and advice.
REPRESENTATIVE GARA stated that he disagreed on this amendment
and would like to adopt different language.
8:58:52 AM
MR. ASHMAN said another concern is that although cheaper and
less-skilled services such as companion services are beneficial
they would require a big fiscal note for the state. He thought
it would be prudent to see what other cheaper alternative
services similar to those are available under Medicaid.
9:06:17 AM
MR. ASHMAN said it would cost the state $10 million in the next
fiscal year to offer companion services and personal care
attendants would be even more costly.
CHAIR DYSON stated most services that seniors need can be
provided by non-medically trained staff. He asked if the purpose
of the bill was to attempt to have those covered under the
federal program.
JANET CLARKE, Assistant Commissioner, Division of Finance and
Management Services, Department of Health and Social Services
(DHSS), said the department considers companion services to be
an expansion of Medicaid. The department made three changes.
One is for a person to come into a home to provide care when a
client is sleeping. This would apply to 10% of claimants. The
second is to provide coverage for a person to provide care for a
patient who is at work, which would apply to 10% of claimants.
The third is to provide companion care in places with medically
trained attendants.
CHAIR DYSON asked what the cost of the expansion would be.
MS. CLARKE replied that it is expected to cost $80 million next
year.
REPRESENTATIVE GARA suggested taking Representative Cissna's
amendment and adding language saying that this waiver shall not
be implemented and benefits shall not be paid until the
department adopts regulations after completing a study to
determine how to approach the problem in the future.
9:12:43 AM
MR. ASHMAN said he did not favor that approach at this time.
CHAIR DYSON announced that the committee would take up the three
House floor amendments at this time. He moved Amendment 1 to
delete House Floor Amendment 1.
AMENDMENT 1
Offered by Representative Gara
Page 15, following line 29:
Insert new bill sections to read:
"*Sec. 20. AS 47.07.070(a) is amended to read:
(a)Except as provided under (d) or (e) of this section, the
[THE] department shall, by regulation, set rates of payments for
health facilities under this chapter and AS 47.25.120 - AS
47.25.300 in accordance with 42 U.S.C. 1396 (Title XIX, Social
Security Act, Medical Assistance) and this section. A rate
established under this section takes effect under AS 44.62
(Administrative Procedure Act) but not until approved in writing
by the commissioner. The commissioner may delegate the
performance of these functions.
*Sec.21 AS 47.07.070 is amended by adding new subsections to
read:
(d) For residential support living services provided to an
eligible recipient of medical assistance living in an assisted
living home licensed under AS 47.33, the minimum daily
reimbursement rate to the assisted living home for room and
board expenses is $28.
(e) A calculation of the rate for administrative and
general costs for a provider, including an assisted living home,
shall be determined in the same way as a calculation for
administrative and general cost rate for a Pioneers' Home. In
this subsection, "administrative and general costs" means those
expenses that are common to the overall operation of a provider
providing home and community-based waiver services and that are
not directly assignable to or borne by a specific program or
recipient of a home and community-based service."
Renumber the following bill sections accordingly.
Page 40, following line 10:
Insert a new bill section to read:
"*Sec.49. AS 47.07.070(c) is repealed."
Renumber the following bill sections accordingly.
Page 40, following line 19:
Insert a new bill section to read:
"*Sec.52. The uncodified law of the State of Alaska is amended
by adding a new section to read: REGULATIONS ANNULLED. 7 AAC
43.1058(k)(1)(B) are annulled."
Renumber the following bill sections accordingly.
Page 45, line 18, following "Sections":
Insert "20,21,49,52"
Renumber all internal references to bill sections in accordance
with this amendment.
REPRESENTATIVES GARA and ANDERSON objected and a roll call vote
was taken. Representatives Anderson, McGuire and Representative
Gara voted nay. Senator Huggins and Chair Dyson voted yea;
Senators Davis voted nay; and Amendment 1 failed.
CHAIR DYSON moved Amendment 2 to delete House Floor Amendment 2.
AMENDMENT 2
Offered by Representative Cissna
Page 41, following line 28:
Insert a new bill section to read:
"*Sec.54. The uncodified law of the State of Alaska is amended
by adding a new section to read: MEDICAL ASSISTANCE WAIVER
APPROVAL; LEGISLATIVE INTENT.
(a) The Department of Health and Social Services shall
proceed immediately to seek federal approval to amend the home
and community based waiver program for the state under Medicaid
to add adult companion services for older Alaskans and for
adults with physical disabilities as a reimbursable service
either as a separate service or personal attendant services. The
services may be combined only if the combination results in
greater efficiency in administering the program and is more
beneficial to the recipient of waiver services.
(b) It is the intent of the legislature to restore non-
medical care, supervision and socialization provided through
companion services to functionally impaired adults who are
eligible for home and community based waivers for older Alaskans
and for adults with physical disabilities. Companion services
were formerly provided as part of respite service before the
amendments to 7 AAC 43.1040. Effective May 15, 2004, the
Department of Health and Social Services was prohibited from
paying for respite services that allow a primary caregiver of an
eligible recipient to work under 7 AAC 43.049(d)(4)(A) or that
are provided during sleeping or nighttime hours. Adult companion
services shall be available under this Act, subject to other
federal and state limits, as part of the recipient's approved
plan of care to allow a primary caregiver to work, to allow a
primary caregiver to sleep during normal nighttime hours when
the recipient of care cannot be safely left unsupervised during
the caregivers' sleep hours, and to allow supervision or
monitoring of the recipient who is not otherwise safe while
sleeping. The department shall enact regulations that are
necessary to implement the legislative intent under this
section.
(c) In this section, "adult companion services" means non-
medical care, supervision, or socialization provided to a
functionally impaired adult in accordance with a therapeutic
goal in the recipient's plan of care under the home and
community based waiver program; for purposes of this subsection,
"therapeutic goal" means a goal that has the effect of delaying
or avoiding placement of the recipient in a more restrictive
environment, including an assisted living home or a nursing
home, and that supports the vital needs for the primary
caregiver of the recipient.
Renumber the following bill sections accordingly.
REPRESENTATIVE ANDERSON objected and a roll call vote was taken.
Representatives Anderson, McGuire and Representative Gara voted
nay; Senator Huggins and Chair Dyson voted yea; Senator Davis
voted nay; and Amendment 2 failed.
CHAIR DYSON moved Amendment 3 to delete House floor Amendment 3.
AMENDMENT 3 (title amendment)
Offered by Representative Croft
Page 1, line 10, following "Services;"
Insert "relating to public assistance for health facilities and
assisted living homes, to rates charged by an assisted living
home, and to the liability of recipients of home or community-
based services to pay for those services;"
REPRESENTATIVE ANDERSON objected and a roll call vote was taken.
Representatives Anderson, McGuire and Gara voted nay; Senators
Huggins and Chair Dyson voted yea; Senator Davis voted nay; and
Amendment 3 failed.
CHAIR DYSON moved that the committee request limited powers of
free conference to continue its business there were no
objections and it was so ordered.
CHAIR DYSON adjourned the meeting at 9:19:24 AM.
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