Legislature(2021 - 2022)BUTROVICH 205
04/26/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB62 | |
| SB242 | |
| SB183 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 62 | TELECONFERENCED | |
| += | SB 242 | TELECONFERENCED | |
| *+ | SB 183 | TELECONFERENCED | |
| + | TELECONFERENCED |
SB 183-HOME AND COMMUNITY-BASED SERVICES
2:13:02 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 183 "An Act relating to home
and community-based services; and providing for an effective
date."
2:13:33 PM
SENATOR ELVI GRAY-JACKSON, Alaska State Legislature, Juneau,
Alaska, sponsor of SB 183, introduced the bill by reading
sponsor statement:
Alaska has recently seen an increased demand for home-
care services from our senior population and those
with disabilities due to both growth in our senior
population and increasing waiting periods to access
home and community-based services. Currently, we are
unable to meet these demands. We have seen many
individuals who qualify for Home and Community-Based
Services (HCBS) waivers and Community First Choice
Medicaid State Plan (K) have service levels cut, get
stuck on waiting lists for long periods of time, or
unable to hire caregivers of their choice. There is a
high need for caregivers yet hourly wages for
caregivers has declined over the past decade.
This harms Alaskans everywhere. Without access to
home-care services, many Alaskans either go without
the care they need, rely exclusively on unpaid and
untrained friends and family members, or are forced to
move thousands of miles away from their community and
support systems to receive institutional care.
SB 183 takes steps to ensure that Alaskans who need
in-home care receive it, so they may live with dignity
and independence at home, while providing more
stability to caregivers. This bill will raise the
threshold for reduction of benefits, ensure benefit
recipients are notified of eligibility assessment
results and their options for appeal, and allow for
re-assessment of eligibility for those whose levels of
service have been reduced over the past two years. It
will make it easier for eligible caregivers to become
Personal Care Assistants under HCBS waivers and the
Community First Choice Medical State Plan (K).
Passing SB 183 helps Alaska meet the in-home care
needs of seniors and people with disabilities. It
ensures more Alaskans can stay in their homes and
communities and maintain their dignity and
independence. It also provides improved stability for
the direct-care workforce. I hope you'll join me in
supporting SB 183.
2:16:00 PM
BESSE ODOM, Staff, Senator Elvi Gray-Jackson, Alaska State
Legislature, Juneau, Alaska, presented the sectional analysis
for SB 183 reading the following:
Sec. 1: Amends AS 47.07.045(a) Home and community-
based services for provisions in the section to apply
also to Community First Choice and Medicaid personal
care services programs.
Sec. 2: Amends AS 47.07.045(a) Home and community-
based services by:
? Introducing a process in statute for reducing hours
or payment for home and community-based services
provided under 1915(k) state plan option and Medicaid
personal care services that mirrors the process for
terminating services.
? Adding "and live independently" as a condition for
terminating services.
Requiring the department to continue following
notice requirements provided in later sections.
Sec. 3: Amends AS 47.07.045(d) Home and community-
based services by:
? Moving definitions for "independent qualified health
care professional" and "independent qualified waiver"
to this section. It does not create any new
definitions.
? "Independent qualified health care professional" for
an intellectual or developmental disability waiver is
defined as a qualified intellectual disability
professional under 42 C.F.R. 483.430.
? For other allowable waivers, "Independent health
care professional" is defined as a person who can
provide personal care services under the 1915(k) state
plan or a registered nurse with specific
qualifications relevant to the waivers.
Sec. 4: Adds a new subsection to AS 47.07.045 Home and
community-based services that:
? Establishes that once the department receives the
results of an assessment they have 10 days to notify,
in writing, the recipients or individuals with legal
authority to act on the recipient's behalf of the
assessment results.
? Establishes that after the department decides if
there will be a change in levels of services or
payments for services, they have 10 days after the
decision is made to notify the recipient or
individuals with legal authority to act on the
recipient's behalf of the decision. This notice must
be done in writing and 30 days before the new
determination goes into effect. The department must
also inform them they have a right to appeal the
decision.
? Allows legally responsible persons to provide
personal care services to an individual eligible for
home and community-based services waivers and
Community First Choice.
Sec. 5: Adds a new section that creates a path for
hours to be restored through the proposed reassessment
process for recipients of care whose payment for
services were reduced between January 1, 2019 and
January 1, 2022.
Sec. 6: Adds a new section to instruct the Department
of Health and Social Services to amend and submit a
state plan for medical services to the Centers for
Medicare and Medicaid Services (CMS).
Sec. 7: Makes section 5 retroactive to January 1,
2019.
Sec. 8: Establishes the act will take effect only upon
federal approval of the state plan for medical
assistance, and that if approved, the Commissioner of
the Department of Health and Social Services must
notify the revisor of statute not later than 30 days
after receiving notice.
Sec. 9-10: Create two effective dates:
? For sections 1 4, effective date will be the day
after the revisor of statutes receives notification
from the Commissioner of Health and Social Services of
federal approval of state plan amendments.
? Sections 5 and 7 take effect immediately upon
passage.
2:20:42 PM
CHAIR WILSON listed the individuals available to answer
questions.
2:21:00 PM
SENATOR BEGICH mentioned a memorandum he received that discusses
the incentive mechanism the [Department of Health and Social
Services (DHSS)] uses and the concern it has with the
legislation that there is an expectation that individuals gain
skills to take better care of themselves. He said his concern is
that some people are never going to gain new skills because they
are permanently disabled. He called the requirement to show
continued progress when it's not possible a loophole in the law.
He asked whether the bill rectified that conundrum.
2:23:19 PM
SENATOR GRAY-JACKSON answered that she believes SB 183 does
rectify that situation because it allows a repeal process. She
suggested that the department could give a more in-depth
response.
2:23:41 PM
JOHN LEE, Director, Division of Senior and Disability Services,
Department of Health and Social Services (DHSS), Anchorage,
Alaska, said he believes the discussion is about a Center for
Medicare and Medicaid Services (CMS) concept called fading that
applies to individuals who have the capacity to obtain new
skills or competencies to perform certain tasks. He acknowledged
that this isn't available for many individuals that the
department supports because their conditions will not get
better. However, for supportive employment there is a CMS
requirement that as skills and competencies are developed, the
supportive process in place will fade.
SENATOR BEGICH referenced page 4 of the memorandum from the
department that indicates that SB 183 would negatively affect
the federal policy called fading.
2:25:42 PM
MR. LEE answered yes; the department would need federal approval
to remove the requirement for fading to be part of the
department's program.
SENATOR BEGICH noted that the memorandum said, "The department
is eager to work with the sponsor to better understand the goal
of the bill." He asked Mr. Lee if he'd met with the sponsor to
discuss the concern.
MR. LEE answered yes and he appreciated that Senator Gray-
Jackson participated in the dialog and was open to potential
changes. The department also met with the sponsor of the House
companion bill who agreed to some positive changes. The
department looks forward to continuing conversations with both
sponsors to improve the legislation and reduce the concerns
articulated in the fiscal note.
SENATOR HUGHES asked if CMS would have to issue a formal waiver
to eliminate the requirement for a person to be developing their
skills to progress towards employment. She also asked whether
individuals who lose eligibility because their skills and
competencies aren't improving are eligible for help under a
different type of funding.
2:28:18 PM
MR. LEE said the bill affects the department's Personal Care
Services Program and the Home and Community Based waiver
programs. To implement the changes the bill calls for, these
three programs would have to make changes to the regulations and
potentially get approval from the Center for Medicare and
Medicaid Services. The department is currently receiving the
American Rescue Plan enhanced federal match for HCBS and because
some of the provisions in the proposed statute would be more
restrictive, it may be necessary to delay implementing the
changes until after March 31, 2024. To the question about
funding, he said the lack of progress toward employment doesn't
typically trigger the loss of that aspect of the person's
waiver. He asked if she could give specific examples of that
happening so he could give a more precise response.
2:30:04 PM
SENATOR HUGHES suggested he follow up with the Governor's
Council on Disabilities and Special Education because she
recalled testimony from people with severe disabilities who have
lost services because they were not progressing. She also asked
whether the regulation changes he mentioned earlier referred to
state or federal regulations.
MR. LEE answered that the waiver and state plan amendments would
require approval from CMS, but he saw no need to change either
federal statutes or federal regulations.
SENATOR HUGHES shared her personal experience when her father
was in a recovery center receiving therapy after hip surgery.
For Medicare to pay, he had to show he was making progress. When
he stopped making progress, he lost the therapy and declined
rapidly. She offered her belief that the requirement to continue
to show progress to stay on a program needs to be revisited with
CMS.
2:33:48 PM
SENATOR BEGICH asked if the two retroactive clauses were due to
COVID-19.
SENATOR GRAY-JACKSON deferred to Ms. Odom.
MS. ODOM answered yes.
SENATOR BEGICH elaborated that it returns to the standard prior
to the COVID-19 pandemic.
SENATOR GRAY-JACKSON agreed.
SENATOR REINBOLD asked for further clarification because January
1, 2019 was before the pandemic.
SENATOR BEGICH said it's set for the beginning of the calendar
year. He suggested the department comment.
CHAIR WILSON noted that the department declined to comment on a
policy call.
2:36:20 PM
CHAIR WILSON turned to invited testimony.
2:36:37 PM
KATHERINE BACON, representing self, Palmer, Alaska, stated that
she has been a special needs caregiver for 25 years, starting
with her medically fragile granddaughter. She is now the primary
caregiver to her late husband's grandson Michael who has a
traumatic brain injury. Countless caregivers have come and gone
because the pay isn't very good. She is fortunate to be paid to
care for Michael, but the process to get qualified to retain a
caregiver let alone to qualify to be a caregiver is too
difficult for a lot of families. Many of the paid and unpaid
people doing this work are struggling and reaching the breaking
point.
MS. BACON described SB 183 as the first small step towards the
urgently needed repair of a broken system by reducing barriers
to access to care and restoring client hours. These two changes
will help keep vulnerable Alaskans like Michael safer.
2:41:09 PM
DEBBIE MULHOLLAND, representing self, Anchorage, Alaska, stated
that she has been a caregiver for nearly 10 years. SB 183 is
important to her clients, most of whom are seniors. They are in
need of care and often can't get it. She shared the following
story from her prepared testimony:
I have one client who is bed ridden and his daughter
has been taking care of him. I only see him five hours
per day, four days per week. I can see that it is very
hard on her mental and physical health because of
physical abuse due to her father's dementia. She
doesn't get any breaks or help from other caregivers
besides me. It worries me that caregivers are
experiencing these kinds of hardships on a daily basis
because there is simply not enough funding for
caregiving.
MS. MULHOLLAND stressed that families are struggling because
they can't find caregivers and caregivers are struggling because
their clients only qualify for two hours of care per day a few
times a week so they leave to find more stable employment. This
often leaves the families to fill the gap. [Audio was
indiscernible.]
CHAIR WILSON advised that the committee could not hear the
testimony.
2:43:33 PM
MS. MULHOLLAND stated that the cuts to the caregiver programs
have gone too far. Some seniors are no longer able to get help
for their most basic needs. She urged the committee to pass SB
183.
2:45:29 PM
CHAIR WILSON opened public on SB 183.
SENATOR HUGHES thanked the caregivers who gave testimony for the
work they do.
CHAIR WILSON asked Mariana Morante if she wanted to provide
testimony or comment on the bill and she declined.
2:46:55 PM
CHAIR WILSON closed public testimony on SB 183.
SENATOR GRAY-JACKSON suggested Ms. Morante address the concerns
DHSS articulated.
2:47:36 PM
MARIANA MORANTE, Research & Policy Manager, Service Employees
International Union (SEIU) 775, Seattle, Washington, stated that
SB 183 seeks to prevent caregiver hours from being cut for
clients who need those services. The bill mirrors the existing
process for terminating services. That involves an independent
health provider conducting an assessment to verify that the
client would be able to function in a home and live
independently. The bill ensures that what the caregivers
provided in testimony today does not happen, so everyone
receives the level of care needed to function in a home and live
independently.
CHAIR WILSON offered his view on indeterminate fiscal notes, and
asked Mr. Lee to discuss how the bill would work, how it would
be implemented, and what it would cost the state.
2:49:32 PM
MR. LEE stated that SB 183 would fundamentally change nearly
every aspect of processing and managing the department's
portfolio of businesses. It would also require extensive
consultation with CMS on how to implement the bill. He justified
the indeterminate fiscal note saying that the number of
processes that would need to be changed and the number of
additional staff that would be needed and managed would vary
depending on whether the Senate or House version of the bill
passed. He opined that it would take weeks of concerted effort
with the entire leadership team to provide a guestimate of the
actual costs to hire additional staff, to contract for third-
party reviews, and to determine what assessments would be
required and when. A final determination would likely be after
public comment and consultation with CSM.
2:51:41 PM
CHAIR WILSON said he appreciates that but legislators rely on
good faith estimates from the departments to make the best
decisions possible.
CHAIR WILSON asked if the bill could be implemented given the
changes the federal government has made to Medicaid, including
the moratorium on enrollment.
MR. LEE opined that certain aspects of the bill would be
problematic and need to be delayed given that the department is
taking advantage of the American Rescue American Rescue Plan
enhanced federal match for certain programs. There may also be
required assessments that aren't currently required and those
would need to be delayed until after March 31, 2024.
SENATOR HUGHES pointed out that the department would also need
to get any waiver applications approved by CMS. She asked if he
agreed that it's more involved than simply passing the bill.
2:53:57 PM
MR. LEE said that's correct.
SENATOR BEGICH commented that he was pleased that the Chair was
on the Finance Committee because the questions about the fiscal
note will be significantly more difficult to answer in that
venue. He also observed that the administration appears to have
no interest in this legislation moving forward. He asked if he
was hearing that correctly.
MR. LEE responded that the department has worked hard and has
had multiple meetings with the sponsors of both the Senate and
House bills. He apologized for giving the impression of no
interest because that was not the intent. There is a lot of
interest in making a better bill, he said.
SENATOR REINBOLD commented that she doesn't have a lot of
compassion for a department that can't come up with a fiscal
note when it's now two departments with addition staff. She said
this is an important issue for the people who need care, the
families, and the caregivers. She added that her problem with
public assistance relates to the expansion of Medicaid. It's
made the budget too large.
2:57:52 PM
SENATOR GRAY-JACKSON stated that this bill is very important and
she appreciates the support. She also agreed with the comment
about the two departments and the indeterminate fiscal note, and
expressed appreciation for Senator Begich's comments.
CHAIR WILSON asked the sponsor if she had any closing comments.
SENATOR GRAY-JACKSON thanked the committee for considering the
bill
2:59:27 PM
CHAIR WILSON held SB 183 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 183, Version A – Supporting Document (Guardianship Overview).pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 183, Version A – Supporting Document (One Pager).pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 183, Version A - Sponsor Statement.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 183, Version A – Supporting Document (Personal Care Services).pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 183, version A.PDF |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| Additional Letters of Support.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| GCDSE Letter of Support 3.14.22.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 183, Version A - Sectional Analysis.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 183 FN DOH MS 4.22.22.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 183 FN DOH SDSA 4.22.22.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 183 |
| SB 242 Ammendments 4.26.22.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 242 |
| SB 242 Letter- Delta 4.20.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 242 |
| SB 242 A1 Memo Wilson 4.25.pdf |
SHSS 4/26/2022 1:30:00 PM |
SB 242 |