Legislature(2001 - 2002)

02/05/2002 03:04 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 366-RATES FOR ASSISTED LIVING FACILITIES                                                                                   
CHAIR  DYSON announced  the next  order of  business to  be HOUSE                                                               
BILL  NO. 366,  "An Act  relating to  assisted-living homes;  and                                                               
providing for an effective date."                                                                                               
Number 2262                                                                                                                     
REPRESENTATIVE COGHILL,  sponsor of  HB 366, introduced  the bill                                                               
by giving  a brief  history of  assisted-living legislation.   He                                                               
implied that  he was  surprised by  the size  of the  fiscal note                                                               
accompanying HB 366;  he had anticipated a zero fiscal  note.  He                                                               
noted  that  in 2000,  the  legislature  passed legislation  that                                                               
provided  for an  increase  to $70  of  the assisted-living  home                                                               
daily rate.   His impression of that legislation,  he stated, was                                                               
that it  would provide "three  hots and a  cot" to clients.   Any                                                               
medical  expenses would  fall under  Medicaid.   He said,  "As it                                                               
turns  out, that's  not exactly  true."   He  indicated that  new                                                               
regulations  are  changing  [the   intended  application  of  the                                                               
legislation].   House Bill  366 is an  attempt to  [implement the                                                               
intent of  previous assisted-living-care legislation]  by setting                                                               
the amount at $70 a day, he explained.                                                                                          
Number 2348                                                                                                                     
REPRESENTATIVE  COGHILL  said that  his  idea  was to  call  this                                                               
amount a "per  diem", which would settle the  issue [of providing                                                               
room and  board for  clients].   He thought HB  366 was  going to                                                               
provide for  that [at no  additional cost] until he  received the                                                               
fiscal note  hours before the hearing.   He stated he  would draw                                                               
up  a    proposed  committee  substitute  (CS)  to  address  [the                                                               
shortcomings of  the present language].   He said he  thinks that                                                               
the  expansion of  long-term care  will  be a  critical issue  in                                                               
TAPE 02-5, SIDE B                                                                                                               
Number 2370                                                                                                                     
REPRESENTATIVE  COGHILL queried:   How  will Alaska  provide care                                                               
for indigent clients?   "We settled on what we  thought was $70 a                                                               
couple  of years  ago; that's  not exactly  true as  I understand                                                               
it," he said.  He noted  that dealing with both state and federal                                                               
laws is problematic.                                                                                                            
Number 2326                                                                                                                     
WES INGRUM testified  via teleconference in favor of HB  366.  He                                                               
stated that he  thinks the real issue is patient  liability.  The                                                               
new  regulations  written by  the  division  have the  effect  of                                                               
reducing the dollars  available for client care, he  said.  Those                                                               
regulations place  more responsibility  on the  provider relative                                                               
to the  hours of service,  the activities of daily  living (ADL),                                                               
and  the instrumental  activities of  daily living  (IADL).   The                                                               
most problematic area,  he noted, is concerning the  issue of the                                                               
ADL, which  can include clients who  require two-person transfers                                                               
or 24-hour-awake staffing.                                                                                                      
Number 2290                                                                                                                     
MR. INGRUM pointed out that  Alaska has no acuity-based fee which                                                               
addresses how many  ADLs are provided to  residents or (indisc.).                                                               
The $70 a day in HB 73  was originally intended to cover room and                                                               
board.   He stated that  HB 366  seeks to clarify  that, although                                                               
some small changes still need to  be made.  The intent, he noted,                                                               
needs to  be delineated  to identify the  basic services  of room                                                               
and board.   This affects  both small homes and  large facilities                                                               
that provide  assisted living.  A  stable fee basis in  Alaska is                                                               
necessary  to  attract  new  facilities   and  staff  to  provide                                                               
appropriate care.   Currently, the  regulations make  dollars for                                                               
necessary service  unavailable.   This will jeopardize  the well-                                                               
being  of the  Alaskan residents  in assisted-living  facilities.                                                               
He pointed  out that anything  done to reduce  dollars [available                                                               
for assisted-living  care] will  reduce the level  of observation                                                               
and care for clients.                                                                                                           
Number 2218                                                                                                                     
MR.   INGRUM   stated   that  the   assisted-living-care   client                                                               
population  is increasing  in Alaska.    Proportionate growth  in                                                               
facilities and staff  is not occurring due to a  lack of funding,                                                               
he offered.                                                                                                                     
Number 2197                                                                                                                     
REPRESENTATIVE WILSON  asked, "What's the difference  between ADL                                                               
and [IADL]?"                                                                                                                    
MR. INGRUM  responded that an IADL  is a minor activity  of daily                                                               
living such  as writing  a letter  or balancing  a checkbook.   A                                                               
person   could  be   quite  functional   and   perform  all   the                                                               
instrumental  activities of  daily living,  he explained,  but be                                                               
unable  to perform  the  IADLs  and some  ADLs  such as  personal                                                               
hygiene,  health care,  and medication  use.   One  of the  first                                                               
subjects  of ADL  is medication  management,  which is  extremely                                                               
critical; some of  a client's other problems may  be reduced when                                                               
he/she is appropriately medicated.                                                                                              
Number 2126                                                                                                                     
MARY   NICHOLSON,  Nicholson   Assisted  Living,   testified  via                                                               
teleconference in support of HB  366.  She thanked Representative                                                               
Coghill for  introducing the  bill.  The  bill, she  noted, would                                                               
enable vulnerable  adults to stay in  assisted-living situations.                                                               
Nursing  home care  is much  more  expensive for  the state,  she                                                               
Number 2109                                                                                                                     
REPRESENTATIVE WILSON  asked Ms.  Nicholson for  clarification on                                                               
the difference between ADL and IADL  and how the funding for each                                                               
impacts assisted-living-care providers.                                                                                         
MS. NICHOLSON stated that the  general relief requested in HB 366                                                               
for  room and  board  increases  over several  years.   This  has                                                               
nothing to do  with the ADL that comes under  the services in the                                                               
augmented rate  for room and board,  which is in addition  to the                                                               
per diem rate, she said.   There is an augmented rate for clients                                                               
requiring more than room and board;  this covers the ADLs and the                                                               
Number 2018                                                                                                                     
REPRESENTATIVE  COGHILL  agreed  that the  issue  with  assisted-                                                               
living  care is  that  it provides  non-medical  care.   Anything                                                               
beyond room  and board is medical  care.  This is  where Medicaid                                                               
funds begin  to be utilized.   He indicated that  new regulations                                                               
have clouded the  funding issue, and that he'd  introduced HB 366                                                               
to bring clarity to the subject of funding.                                                                                     
Number 1973                                                                                                                     
DEBBIE  CASH, Owner-Operator,  Debbie's Fireside  Home, testified                                                               
via teleconference  in support of  HB 366.   She listed  the many                                                               
items that  fall under  the definition  of room  and board.   She                                                               
noted that these  costs have increased over the past  years.  She                                                               
indicated  that   new  dietary  documentation   requirements  are                                                               
[unfunded mandates]  and [require the knowledge  of a dietician].                                                               
Some clients  in her home,  were they to  be placed in  a nursing                                                               
home, would  cost the state  $390 a day  for room and  board, she                                                               
offered.   She questioned how  the legislature could  justify not                                                               
spending  $70 a  day for  room  and board  and  $70 a  day for  a                                                               
client's [ADL and IADL] needs.   She compared this $140 a day [in                                                               
an assisted-care facility]  to the $390 a day at  a nursing home.                                                               
She concluded, "We  are giving you guys a very  fair shake."  She                                                               
stated  that older  people deserve  to  live with  respect.   She                                                               
added that she  was able to purchase  a wheelchair-accessible van                                                               
for transporting clients with the additional funding.                                                                           
Number 1780                                                                                                                     
BOBBY  CASH  testified  via teleconference.    He  expressed  his                                                               
perplexity at the way  payments to assisted-living-care providers                                                               
are diminished  by various funding  entities.  He stated  that he                                                               
hoped the state  would establish an amount it would  pay and then                                                               
follow through  with that amount.   He noted  that transportation                                                               
of clients was an issue for providers.                                                                                          
Number 1680                                                                                                                     
MONTA  FAYE  LANE,  President,  Assisted  Living  Association  of                                                               
Alaska,  testified  regarding  her  experience  as  an  assisted-                                                               
living-home owner.   She began providing  assisted-living care in                                                               
1991.   She was  initially prohibited from  accepting wheelchair-                                                               
bound clients  or clients who needed  to be lifted.   Clients who                                                               
became  bed-bound under  her  care needed  to  be transferred  to                                                               
nursing homes quickly, according  to guidelines from the attorney                                                               
general,  Ms.  Lane stated.    She  offered  an overview  of  the                                                               
changes in  regulations and  funding from 1991  to 1995  when the                                                               
Division of Senior Services was established.                                                                                    
Number 1537                                                                                                                     
MS.  LANE said  that  the waiver  program,  established in  1995,                                                               
permitted clients requiring more  care to choose assisted living.                                                               
This  is what  the Medicaid  waiver-choice program  provided, she                                                               
explained.  The  general relief was $34.50 a day  for clients who                                                               
could not  pay for their  own care.   That was  supplemented with                                                               
the waiver, which  was $44.60 a day.  These  two amounts combined                                                               
had to cover  room and board plus medical needs.   She noted that                                                               
a plan of care is prescribed  for clients covered by the Medicaid                                                               
waiver.   This plan of care  must be administered by  a certified                                                               
nurse's aide  (CNA).  She stated  that small assisted-living-care                                                               
providers have difficulty procuring  CNAs when the Pioneers' Home                                                               
entry-level wage for CNAs is about $14 an hour.                                                                                 
Number 1409                                                                                                                     
MS.  LANE  referenced  legislation  in  1999  intended  to  raise                                                               
payments to  assisted-living-care providers that failed  to pass.                                                               
She noted that  SB 73 in 2000  raised the rate to $50  a day; the                                                               
raise did not  go into effect until September of  that year.  The                                                               
rate increased  to $60 a  day in June 2001,  and is slated  to be                                                               
raised  to   $70  a  day  in   July  2002,  she  offered.     The                                                               
administration's proposal,  she indicated, is to  take 60 percent                                                               
of  that   $70  away  from  assisted-living-care   providers  and                                                               
increase the Medicaid  [payment].  She stated  that providers are                                                               
delivering medical services for which  they receive $70.19 a day.                                                               
So providers are  receiving $130.19 a day, she  said, in contrast                                                               
to $396 at nursing homes and $290 at the Pioneers' Homes.                                                                       
Number 1351                                                                                                                     
REPRESENTATIVE COGHILL  pointed out that a  provider's receipt of                                                               
two different funds,  one for home care and  another for medical,                                                               
could be construed  by some to be being paid  twice [for the same                                                               
Number 1320                                                                                                                     
MS. LANE  replied that she has  never been paid twice.   The rate                                                               
received by  providers was  set by  the division,  she explained.                                                               
Federal  and state  law dictate  Medicaid payments  as well,  she                                                               
Number 1291                                                                                                                     
REPRESENTATIVE COGHILL  noted that  this issue  would be  part of                                                               
future discussion [pertaining to HB  366] of payments by Medicaid                                                               
and payments under the general relief dollars.                                                                                  
Number 1245                                                                                                                     
CHAIR  DYSON  expressed   appreciation  for  assisted-living-care                                                               
providers.  He acknowledged two  witnesses who concurred with Ms.                                                               
Lane's testimony.                                                                                                               
Number 1182                                                                                                                     
MS.  LANE  remarked  that  her observation  has  been  that  some                                                               
doctors  are refusing  to treat  Medicaid patients.   She  asked,                                                               
"What are  you going  to do if  the assisted-living  homes refuse                                                               
Medicaid clients?"                                                                                                              
CHAIR DYSON  replied that Ms. Lane's  point was well taken.   [HB
366 was held over.]                                                                                                             

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