Legislature(1995 - 1996)
03/12/1996 03:03 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
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+ teleconferenced
= bill was previously heard/scheduled
HB 528 - NURS.HOME MORATORIUM/CERTIFICATES OF NEED Number 1251 CO-CHAIR TOOHEY said this bill had been heard in committee previously and she had two amendments to distribute to committee members. Co-Chair Toohey moved to adopt Amendment 1. Hearing no objection, Amendment 1 was adopted. CO-CHAIR BUNDE asked Co-Chair Toohey to explain Amendment 1. CO-CHAIR TOOHEY said she is requesting the language in Section 2, page 2, line 19 be changed from "may" of the original language to "shall" with a specific moratorium so a specific plan can be established at the end of two years to address the existing concerns. CO-CHAIR BUNDE said the amendment returned the language to the original language. REPRESENTATIVE VEZEY raised an objection. He didn't understand why the committee wanted to make it mandatory that the Administration approve every request for a new facility. CO-CHAIR TOOHEY asked Kim Duke to respond to Representative Vezey's question. Number 1442 KIM DUKE, Researcher to Representative Mark Hanley, House Finance Committee, explained there were different items the Department of Health & Social Services had to take into consideration before a recommendation was approved and Section 2 expands that so the statewide financial need for additional beds would also be considered. She added that Representative Hanley is not opposed to the amendment, as written. CO-CHAIR BUNDE explained the amendment would reflect existing statute and it had been determined that hospitals or nursing homes can't be built without a certificate of need. MS. DUKE said, "Right. They have expanded language in this area to take other -- language is expanded to allow the department, if they find a lack of available health care resources in this state, and also take into consideration services that are more cost effective, which is the point of this whole bill, is to allow the department time to explore more community based services and this will be one of the considerations they have to take into -- before they approve a CON (Certificate of Need). It expands that." CO-CHAIR TOOHEY commented that several years ago Project Choice came to Alaska, which allowed senior citizens to go into community nursing assisted living care in lieu of a nursing home. The cost of assisted living care is $13,000 per year, whereas a bed in a nursing home is $80,000 per year. This legislation expands the assisting living services in the communities. REPRESENTATIVE VEZEY said he still didn't understand why the use of "shall" was better than "may." MS. DUKE said she believed the nursing association was concerned that once all the requirements were met, the department still had leeway to not approve their certificate of need. She believed with the expansion of the criteria, there would be enough restrictions before they are required to approve a CON (certificate of need). REPRESENTATIVE VEZEY disagreed. He explained the use of "shall" would give people a position to sue the state for not funding a program. There are all kinds of need, but there's the question of a lack of money to fund all of the needs. MS. DUKE say there is a requirement to take into consideration the state and federal financing available for these services before determining that a certificate be granted. REPRESENTATIVE VEZEY didn't see where a lack of funds is grounds for saying the need doesn't exist. CO-CHAIR BUNDE asked for a roll call vote. Voting in favor to adopt Amendment 1 were Representatives Robinson, Davis, Rokeberg, Toohey and Bunde. Voting against the adoption of Amendment 1 were Representatives Brice and Vezey. CO-CHAIR BUNDE announced that Amendment 1 had been adopted. He asked Co-Chair Toohey to explain Amendment 2. Number 1745 CO-CHAIR TOOHEY stated that Amendment 2 establishes a working group to study the issues and report on long-term care. The Alaska State Hospital & Nursing Home Association and the Department of Health & Social Services felt there were some major concerns that needed to be addressed as this is a large growing segment of our population. The department has assured there would be no cost for the working group. The report would be worked on during the interim and delivered to the legislature by the first day of the Twentieth Alaska State Legislature. At the end of two years when Sections 1 and 3 sunset, it is hoped that some of the questions and concerns can be answered. REPRESENTATIVE ROKEBERG asked if there was a reason why no one from the legislature was involved in the working group. CO-CHAIR TOOHEY responded there was no particular reason. Number 1851 REPRESENTATIVE DAVIS said he would like to consider an amendment to the amendment by changing "1998" to "1997". He commented that last year there was a long range fiscal planning group that accomplished a lot of work in one year. He assumed there were statistics and data already available, so he felt the group could have their work completed in a year. Representative Davis made a motion to amend the amendment by changing the date in the title from July 1, 1998 to July 1, 1997. CO-CHAIR TOOHEY commented she had no objection to the amendment to the amendment. CO-CHAIR BUNDE inquired if there was any objection to Amendment 2. Hearing none, Amendment 2 was adopted. Number 1985 CHRISTINE CULLITON testified her daughter, Courtney, was born in Alaska 11 years ago, before home and community based services were available. What was available to her family was to divorce, (indisc.) institutionalize or give their daughter up to foster in order to get Medicaid benefits to keep her with them. The family ultimately ended up in bankruptcy trying to keep Courtney in their home, but she ended up in an institutional setting. As a result of OBRA 87, her daughter was able to come back to the state of Alaska, but not to their home. Courtney was what Ms. Culliton considers to be one of the victims of a hospital association bed. The money was tied up in that bed and her cost in the institution was $178,000 for one year of care. Because there were no home and community based services available, Courtney went into foster care in Alaska, which cost the state $57,000 per year, and kept her out of her home and away from the family that loved her. After three years of being in foster care, the family found out that Courtney is terminally ill. Courtney and her family lost the opportunity to be together as a family during the four years she spent in a hospital bed and state money went to hospital bed services. Ms. Culliton remarked that she sat on Project Choice from the conception of the project and helped with the TEFRA Option. When she hears and sees what community based services are currently doing in the state, she brims with pride. She encouraged the committee to support this bill for a two-year moratorium. She commented the state of Alaska has only had the opportunity for home and community based services for two years, the first of which was a rough year because it was a new philosophy for the state. She agreed with Mr. Knudson's comment made a few days previous that this issue has made friends from opposite sides of the fence. She said it's unfortunate because ultimately the goal for everyone is to look out for the best interest of individuals in the state and how best to meet those needs. She asked committee members to walk the two blocks up and two blocks over to St. Ann's Nursing Home and ask anyone of the individuals in the beds if that was their choice. If they had been given the opportunity to stay in their home with their loved ones and receive community based services, would they have chosen that bed? Of course the answer would be no. Ms. Culliton said not one of us is more than a walk across the street away from needing home and community based services or an institutional bed, if that's all that is available. Given the reductions proposed by the House to home and community based services and the administrative costs that have been proposed, in addition to looking at this certificate of need bill, people like her daughter will be forced back into institutional care, and the cost will not just be monetary. She encouraged the committee to allow the state to continue with the success currently experienced with home and community based services. Courtney has been living at home for two years and is receiving the services she needs at a cost to the state of less than $30,000 per year. TAPE 96-25, TAPE A Number 001 MS. CULLITON continued to not allow that moratorium, to have the certificate of need continue, to have those beds be built, will reduce adult funding for services under Medicaid. She commented that adults in the state have already taken a severe reduction in dental, vision, physical therapy and other services from the optional listing in the face of budget reductions. It's disheartening to see those services removed and to think of spending money for a facility that will not support the people in their homes and communities. She thanked the committee for the opportunity to testify and again urged the committee to pass the bill. CO-CHAIR BUNDE asked Jay Livey to come forward to testify. Number 152 JAY LIVEY, Deputy Commissioner, Department of Health & Social Services, said he understood the effect of Representative Davis' amendment to Amendment 2 was to change "1998" to "1997" on line 1 of the amendment, which changes the date in the title of the bill. He said Section 5 of Amendment 2 sets the time of the subcommittee's report back to the legislature as the first day of the Twentieth legislature, which is next January. He believed that what Representative Davis wanted to accomplish with his amendment to the amendment, was already done in Amendment 2. CO-CHAIR BUNDE said with the committee's permission, the amendment to the amendment would be withdrawn, and the committee would have then adopted Amendment 2 unamended. According to Deputy Commissioner Livey's testimony, the amendment moves the report up to the Twentieth Legislature, which is next January. REPRESENTATIVE ROKEBERG thought the amendment was to move the period of moratorium from two years to one year. REPRESENTATIVE DAVIS said that was his intent. CO-CHAIR BUNDE said the committee had already adopted Amendment 2, as amended and he assumed Representative Davis would object to removing his amendment to the amendment. Number 307 REPRESENTATIVE DAVIS said, "My desire was to have -- I think the study group when it comes back with its report, would have any basis for establishing this statute - this bill. If the bill is valid and there is a concern and the study recommends an extension to another year as initially indicated in the bill - they wanted a two-year moratorium - I want a one-year moratorium with the understanding that the working group is going to go out and analyze the situation as it stands now which will then verify the need for this legislation. If it says yes, we need this protection from additional expenses, then we would come back and extend the moratorium at that time. That was my intent. That's what I see the task of the working group is to determine whether there is a need for this legislation for two years." CO-CHAIR TOOHEY asked Mr. Livey to comment. Number 415 MR. LIVEY said the department believes a two-year moratorium was more reasonable for what was trying to be accomplished, which is to create an atmosphere where more home and community based services can develop. That will more likely occur if individuals know that for two years there is a moratorium and during those two years work will be done on developing a home and community based system, instead of a one-year moratorium with maybe a second year. It was the department's desire that the two-year moratorium be retained. REPRESENTATIVE ROBINSON commented it was her understanding the goal was to look at the big picture regarding long term care. She asked if Mr. Livey perceived that the working group would determine if there was a need for a two-year moratorium? MR. LIVEY responded the purpose of the working group was to determine the number of individuals who could be served in the community or in a nursing home, what the relative costs were between the home and community based services and the nursing home and to do some long term planning that would predict where individuals would have to go in the system as they get older. REPRESENTATIVE ROBINSON asked if the department would need to come back before the legislature in order to go to a one-year moratorium if the working group decided the need for a two-year moratorium did not exist. MR. LIVEY thought it would depend on how Section 4 of the current bill was rewritten, because Section 4 contains the moratorium language and states that the moratorium will survive until July 1, 1998. Number 618 CO-CHAIR BUNDE commented that for the information of the committee, some committee members thought the amendment changed one date, but a more significant part of Amendment 2 had been changed. Therefore, the committee needed to move to rescind Amendment 2, then rescind amending Amendment 2, if desired. REPRESENTATIVE BRICE commented that he agreed with Representative Davis on going back to July 1, 1997, because it would require the next legislature to address the issue. He believed it would benefit the long care system if discussions continued and that plans to move ahead in this area should be based on need and cost, as well. He thought a one-year moratorium was the appropriate way to go. REPRESENTATIVE DAVIS agreed with Mr. Livey's argument for wanting two years to pursue long term care and assisted living alternatives, but Representative Davis thought it could be done in one year. He pointed out that with Amendment 2 in place, the date in Section 4 would need to be changed to July 1, 1997. REPRESENTATIVE DAVIS made a motion to adopt Amendment 3 to change the date in Section 4 to July 1, 1997. CO-CHAIR BUNDE noted it was a clarifying amendment. An objection was raised. Number 810 REPRESENTATIVE ROBINSON said she understood Section 4 was the two- year moratorium section, so Amendment 3 would change it to a one- year moratorium. CO-CHAIR BUNDE clarified the amendments. The date of the report back to the legislature was amended in the amended Amendment 2. Amendment 3 reduces the moratorium from two years to one year. A vote against Amendment 3 is a two-year moratorium with an interim report to the legislature. A vote for Amendment 3 is a one-year moratorium with a one year report to the legislature. REPRESENTATIVE BRICE asked when the report would be coming to the legislature? It was his understanding that it changed back to the original language of the first day of the First Regular Session of the Twentieth Alaska State Legislature, so there would be 120 days in which to act to extend the moratorium. CO-CHAIR BUNDE said as the bill exists currently, the report will be provided on the first day of the Twentieth Legislature, but the moratorium will still exist for two years. If Representative Davis' amendment is adopted, the report would be due to the legislature on the first day and the moratorium would cease on the first day. REPRESENTATIVE BRICE interjected on July 1. CO-CHAIR BUNDE stated that was correct; it would be July 1, 1997. Number 913 REPRESENTATIVE ROKEBERG said to further complicate matters, if the amendment is voted down, they would need to go back and fix the title, because they had amended it in Amendment 2. REPRESENTATIVE ROBINSON repeated her earlier question of whether or not the department could lift the moratorium without legislative action. Number 974 MR. LIVEY asked Representative Robinson to clarify her question. REPRESENTATIVE ROBINSON asked if the bill is left as it currently exists with the report coming back in one year and working group decides a two-year moratorium is not what should be done, can the department lift the moratorium on their own at that point? MR. LIVEY said it was understanding, based on committee action taken, the department could not grant a moratorium or license a long-term care bed until July 1, 1997. REPRESENTATIVE ROBINSON interjected her question was based on the bill as it currently exists, and based on his response she assumed it would be July 1, 1998, instead of July 1, 1997. MR. LIVEY responded that was correct. CO-CHAIR BUNDE said the moratorium is in effect until 1998 as the bill exists right now, with the second amendment. The effect of Amendment 3 would be a report in one year and the moratorium would last for one year. REPRESENTATIVE VEZEY asked where does it state that the moratorium would sunset in July 1, 1997. CO-CHAIR BUNDE replied in Section 4. He asked if committee members were clear on Amendment 3. REPRESENTATIVE VEZEY replied no. Amendment 2 was adopted by the committee so Section 4 is now Section 6 in the original bill. REPRESENTATIVE DAVIS said, "So now we revert back to Amendment 2 which says in Section 5, `Section 4 of this Act is repealed on the first day of the First Regular Session of the Twentieth Alaska State Legislature.' So what calendar date would that be?" REPRESENTATIVE ROKEBERG stated he did not like that. REPRESENTATIVE DAVIS said, "Mr. Chairman, we need to relate the actual date of the First Regular Session of the Twentieth Alaska State Legislature with July 1, 1997." REPRESENTATIVE ROKEBERG asked if it should be July 1, 1997? REPRESENTATIVE BRICE responded affirmatively. REPRESENTATIVE DAVIS withdrew Amendment 3. CO-CHAIR BUNDE noted without objection, it was so ordered. Number 1140 REPRESENTATIVE BRICE pointed out the new Section 6 needed to read July 1, 1997. REPRESENTATIVE DAVIS referred to page 2 of Amendment 2, and said Section 5 of the Amendment should be amended to read, "Section 4 of this Act is repealed on July 1, 1997." REPRESENTATIVE BRICE commented the new Section 4 is the study group. REPRESENTATIVE DAVIS suggested the committee review the legislation before any further action is taken. CO-CHAIR BUNDE closed public discussion and announced he was placing HB 528 in a study group headed by Co-Chair Toohey.
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