Legislature(2023 - 2024)ADAMS 519
04/12/2023 01:30 PM House FINANCE
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Audio | Topic |
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Start | |
HB58 | |
HB59 | |
Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
+ | HB 58 | TELECONFERENCED | |
+ | HB 59 | TELECONFERENCED | |
+ | TELECONFERENCED |
HOUSE BILL NO. 58 "An Act relating to medical assistance for recipients of Medicaid waivers; establishing an adult care home license and procedures; providing for the transition of individuals from foster care to adult home care settings; and providing for an effective date." 1:36:52 PM TONY NEWMAN, ACTING DIRECTOR, DIVISION OF SENIOR AND DISABILITIES SERVICES, DEPARTMENT OF HEALTH, explained that the bill would add to the array of services under the Medicaid Home and Community Based Waiver Program. He provided a PowerPoint presentation titled "State of Alaska Department of Health: House Bill 58: Adult Home Care," dated April 4, 2023. 1:37:47 PM Mr. Newman turned to slide 2 titled Senior and Disabilities Services Medicaid Home and Community Based Waivers: • Allow people with disabilities and seniors to remain in their homes or local community settings when they would otherwise need institutional care. • Home and Community Based Waivers receive a 50% Federal and 50% General Fund Match • Alaska provides five home and community-based waivers: 1. Intellectual and Developmental Disabilities waiver (serving about 2,000 people) 2. Alaskans Living Independently waiver (2,200 people) 3. Children with Complex Medical Conditions waiver (225 people) 4. Adults with Physical & Developmental Disabilities waiver (144 people) 5. Individualized Supports waiver (500 people) 1:39:20 PM Mr. Newman provided examples of the types of Alaskans served by waivers. He exemplified that the first type of waiver would serve a senior who suffered a stroke that resulted in permanent limited mobility. The second waiver would serve someone with cerebral palsy or a disabled person able to live at home with support. He interjected that waivers provided people with more independence and personal choice as well as saved the state significant amounts of money that would otherwise be spent on institutional care. He turned to slide 3 titled Services Available Under Alaska's Medicaid Home and Community-Based Waivers: Residential Habilitation (Group Home, Family Home Habilitation) In-Home Supports Supported Living Day Habilitation Ault Day Services Respite Supported Employment • Transportation • Environmental Modifications • Meals • Specialized Medical Equipment • Nursing Oversight • Intensive Active Treatment • Specialized Private Duty Nursing and Care Coordination Mr. Newman delineated that not all services were available for every waiver; some only provided one service, some provided many services, some only applied to group living homes, and some were only for in-home care. All waivers relied on care coordinators who set up a plan and helped waiver recipients take advantage of resources in their community. He detailed that care coordinators were not state employees. They were community members who worked for private agencies throughout the state. 1:40:08 PM Mr. Newman moved to slide 4 titled Options for 24/7 Residential Care for People on Medicaid Home and Community Based Waivers. He expounded that HB 58 provided elderly Alaskans and adults with disabilities who were enrolled in Medicaid home and community-based waiver services with a new living option: Adult Home Care. The bill established a new licensed residential setting type: Adult Care Home. The vision was that the service and setting would offer reduced administrative burdens compared with current assisted living options but still ensure the care and safety of the resident. The legislation would help address the shortage of services and settings for seniors and other individuals who required help with the activities of daily living and other assistance to live more independently and created an option that may enable some people to remain in a community. He exemplified a provider as someone who could provide space like an extra bedroom but was unable to provide all of the care. The idea for the bill had first been brought to the governor's attention by constituents who were serving as foster parents for children with severe disabilities that were aging out of the foster care system and the only way to continue to provide care was to turn the home into an assisted living home, which had many requirements. The department realized that a new type of home care setting could be of value to other individuals with disabilities including senior citizens. He pointed to the proposed Adult Care Home information box on the right lower corner of the slide and informed the committee that there would be different administrative expectations compared to assisted living homes. He indicated that the reduced requirements would be worked out in regulation as well as many other aspects like the type of credentials caregivers would need, the rate of payment, etc. The division would invite much input from its partners that included care coordinators, families, service providers, advocacy groups, etc. and from the Center for Medicaid and Medicare Services (CMS). The drafted regulations would be subject to a public comment period. Mr. Newman concluded that the bill provided a conceptual framework to implement the new waiver. The bill was necessary due to the lack of care options, growth in the senior population, and workforce shortages. The situation required that the department think creatively and provide more options to help people get necessary care while living as independently as possible. The concept was especially important in small communities that lacked good care options. The department expected that Adult Home Care would grow in popularity and ultimately be an attractive alternative for Alaskans. 1:43:07 PM Mr. Newman concluded the presentation and offered to go through the sectional analysis. Co-Chair Foster requested a review of the sectional. Mr. Newman reviewed the sectional analysis (copy on file): Section 1. Adds a new section in AS 47.07, Medicaid Assistance for Needy Persons, declaring that the state shall pay for adult home care services for an individual at a daily rate set by the department in regulation for individuals on Medicaid who are at least 18; enrolled in a home and community-based waiver under AS 47.07.045; if the individual's support plan is approved for adult home care services; and if they person providing the services to the individual holds an adult care home license issued under AS 47.32. This section also allows individuals to receive habilitative and rehabilitative care in addition to adult home care services and directs the department to adopt regulations setting a rate for the service, establish standards for operating an adult care home, and establish a procedure for transitioning an individual from a licensed foster care home to a licensed adult care home. This section also directs the department to establish a simple and efficient process to allow a foster parent who holds a foster home license issued under AS 47.32 to transition from the foster home license to an adult care home license for purposes of maintaining the placement of and services provided to an individual who is transitioning out of foster care, enrolled in a waiver, and at least 18 years of age. Section 2. Amends AS 47.32.010(b) to add a new entity, "adult care homes," that shall be subject to the centralized licensing functions of the department. Section 3. Adds a new section to AS 47.33 that defines the conditions under which the department may license an adult care home. A person may be licensed to operate such a home for an individual who is at least 18 years of age and enrolled in Medicaid and home and community-based waiver services. An adult care home may provide 24-hour oversight and care for up to two adults for compensation or reimbursement under the adult home care service, allows the department to establish standards in regulation to authorize care for up to three individuals based on unusual circumstances; and defines "care" as providing for the physical, mental, and social needs of an individual. Section 4. Amends AS 47.32.900(2) to add adult care homes to the list of settings that are not defined as assisted living homes. Section 5. Amends AS 47.32.900 to add a definition of adult care home, meaning a licensed home, not a business site, in which the adult head of household resides and provides 24-hour care on a continuing basis for eligible individuals. Section 6. 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 home care services and other long-term care services that are not duplicative. Section 7. Amends uncodified law by adding a new Conditional Effect Notification section specifying that Section 1 takes affect if the United States Department of Health and Human Services approves amendments to the state plan submitted under Section 6 by July 1, 2027, and adds requires the commissioner of health to notify the revisor of statutes in writing within 30 days that those amendments were approved. Section 8. Provides for an effective date for any portion of section 1 as the day after the revisor of statutes receives notice from the commissioner of health, per Section 7. 1:45:32 PM Co-Chair Foster referenced the fiscal notes. He stated that committee members could ask questions about fiscal notes during the current meeting and receive an answer the following meeting. Representative Josephson supported the legislation. He understood that the current fiscal notes were in anticipation of implementing the program. He asked once the program was running what the General Fund (GF) need would be. He asked if it would be possible to decrement other programs for services that were no longer necessary due to the new care type. Mr. Newman answered that the fiscal notes addressed hiring two new staff. He elaborated that one would be placed in the Division of Senior and Disabilities Services (SDS) to administer the adult home care service by certifying and monitoring providers. The other staff would be housed in the Division of Health Care Service for licensing needs. There was not a fiscal note for Medicaid Services because the Adult Care Home service would serve as an alternative to the existing service and in some cases, it would be more expensive and, in some cases, it would be less expensive. He anticipated that costs would breakeven and DOH did not anticipate an increase in Medicaid serve costs. 1:48:11 PM Representative Stapp looked at both of the positions under the fiscal notes. He wondered whether all of the backend work as far as the waiver application process through CMS was already completed. Mr. Newman answered in the negative and added that the work had not yet been done. He noted that the department had a policy team that did the work of interfacing with CMS when changes to the waivers were made. Representative Stapp stated that applying for a waiver typically had an associated cost. He asked if the cost was already covered and assumed the department could handle it with existing resources. Mr. Newman responded in the affirmative. Representative Galvin assumed that other states had similar issues and turned to similar programs. She asked if there was data that could help detail the ongoing costs of the proposed program. Mr. Newman responded that one of the challenges with comparing the waiver program with other states was that every state's waiver program was different. He delineated that Washington and Oregon had similar programs in place with different names, but the idea was similar across the board in other states as well. The program enabled turning private homes where seniors and those with disabilities could live and subject them to lower licensing requirements than assisted living homes. They would become a less expensive alternative than nursing homes and other institutional care. 1:50:48 PM Representative Galvin asked for verification that the proposal had been proven to be less of an expense than institutional care. She voiced that it was reassuring to hear other states had successful programs. She wondered how long the program had been in effect in other states. Mr. Newman replied that the programs had been in existence for years, but he did not know the exact length of time. Co-Chair Johnson asked how many people the department expected to be part of the program over time. Mr. Newman answered there were currently about 5,500 Alaskans on Home and Community Based Waivers, with approximately 2000 residing in institutional care or assisted living homes. He elaborated that the program intended to serve a smaller subset of people. He did not know the number of people that would eventually sign up. He noted that the fiscal note was estimated at 40 people occupying the homes in the first few years. Co-Chair Johnson looked at the fiscal note that remained the same until FY 2029 when a new position was added. She asked if the funding would be automatically added to the base without coming back to the legislature. 1:53:43 PM Mr. Newman responded that he was not certain how it worked. He guessed that there was some sort of true up that informed the legislature of the intended funding for a new position. Co-Chair Foster remarked that the next bill hearing would include authors of the fiscal notes that could answer questions. Mr. Newman interjected that someone from the department was online to answer the question. He indicated that the question of anticipated need for the program in the outyears could be answered. ROBERT NAVE, PROGRAM MANAGER, DIVISION OF HEALTH CARE SERVICES, DEPARTMENT OF HEALTH (via teleconference), replied that the forecasted need for the extra position in FY 29 was based off the current caseload of a Community Care Licensing Specialist 1, which was 76 assisted living homes. The anticipated increase in licensing needs created the need for the secondary position in FY 29. Co-Chair Johnson was curious about whether the increase in the outyears would be automatic because it was in the fiscal note. Co-Chair Foster indicated that he would reach out to the Legislative Finance Division for an answer. Co-Chair Johnson asked where the new positions would reside. 1:56:23 PM Mr. Newman believed the positions would be located in Anchorage. Representative Coulombe pointed to a bullet point on slide 4 that stated, less administrative requirements. She acknowledged that the requirements would be forthcoming. She cited page 1, Section 1 of the bill and noted the requirements were establishing a daily rate, standards for care, standards for operating and transitioning, etc. She understood the concept that there should not be as many requirements as in assisted living homes, but it appeared that many requirements could not be eliminated. She was concerned because it was often family members providing care and if they had to jump through so many hoops to get a license it could create a second waiting list. She wondered if there was a discussion about removing some of the assisted living requirements from the list. Mr. Newman answered that the department had compiled some ideas regarding lowering the administrative burden. He detailed that currently an assisted living home was required to maintain three months of operating reserves. He desired to waive that requirement and reduce other administrator requirements. He reported that there was a degree requirement to operate an assisted living home which he wanted removed or lessened. There was a small licensing fee to provide assisted living, which the department would like to see waived. In addition, the DOH wanted to remove square footage requirements. The department intended to engage with the stakeholders for input. Representative Coulombe favored the ideas. She asked about the few bad actors that may try to take advantage of the program. She wondered if there had been discussion around follow ups or how the service would be monitored and inspected to ensure client safety. Mr. Newman answered that it would be a certified service and the service would need to be renewed with the division and licensure renewal included home visits and monitoring. 2:00:19 PM Representative Coulombe asked what the ramifications would be if a person was not taking good care of their residents. Mr. Newman responded that the individual receiving care would not lose their waiver. The department would suspend certification if the provider was not living up to the standards and requirements and waivers could revoked. Representative Ortiz asked if the purpose of the bill was to make homecare more available in Alaska and more affordable and advantageous for people to consider providing the services in their homes because the services would be covered through Medicaid. Mr. Newman confirmed that Representative Ortizs summary of the bill was correct. He added that the bill was intended to provide more home style alternatives so people could stay in their home or community and also enable more providers to become available. Representative Ortiz deduced that the provider would also be motivated by the ability to get some reimbursement for the service. Mr. Newman answered in the affirmative. Representative Ortiz asked whether HB 58 enabled more options available in rural areas. He asked if monitoring in rural areas was possible. 2:03:53 PM Mr. Newman responded that providing services in rural areas was exactly the hope, particularly in rural communities where assisted living was lacking. The driving force of the legislation was to enable people to remain in their communities. Representative Ortiz thought the concept sounded good. Representative Hannan relayed that she had a family member in care that passed away and was assessing the bill as it related to her experience. She referenced the sectional analysis that stated the head of the household lived in the residence and provided 24 hour care. She wanted to ensure that her interpretation was not so narrow as to assume the person was the only caregiver. She wondered whether other caregivers were allowed or was it reliant on only the head of the household as caregiver. She noted that no individual could provide 24 hour care for very long. Mr. Newman replied that one of the things he was most looking forward to with HB 58 was to decide on the ancillary services that would assist the caregiver. He pointed to Section 1 of the bill that allowed an individual may receive habilitative and rehabilitative care in addition to adult home care services. He delineated that the resident would receive supplemental services. The details would be worked out with stakeholders to determine what mix of services would be available. The homeowner would be expected to provide a certain level of care and what needed to be determined was the supplemental care services. Representative Hannan shared that when her sister needed increased overnight care and had finally agreed to assisted living, she needed a nurse to administer medications. She hoped that in the proposed adult home care model a caregiver could administer medications, or the person would need to reside in a nursing home. She added that current assisted living homes were not set up to administer medications. She presumed the division was fully aware of the situation. 2:08:22 PM Mr. Neuman replied that every case was different and emphasized that every person needed different care and a different level of care. He noted that one of the waiver services called nursing oversight where a nurse could be available to a caregiver. Co-Chair Foster reiterated that there would be a deeper dive into the fiscal notes in the next bill hearing. HB 58 was HEARD and HELD in committee for further consideration.
Document Name | Date/Time | Subjects |
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HB 58 LFD Response to Q Out Year FN Costs 041323.pdf |
HFIN 4/12/2023 1:30:00 PM |
HB 58 |