03/19/1998 04:37 PM House MLV

HB 464 - NURSING CARE AT STATE VETERANS' HOME                                  
                                                                               
Number 1945                                                                    
                                                                               
CHAIR MASEK announced the last order of business would be HB 464               
"An Act relating to state veterans' home facilities," sponsored by             
the House State Affairs Committee.                                             
                                                                               
BARBARA COTTING, Legislative Assistant to Representative Jeannette             
James, Alaska State Legislature, came before the committee to                  
explain the legislation.  She informed the committee members that              
several weeks ago Veterans Organizations visited her office and                
presented some of their legislative priorities and HB 464 is a                 
result of her conversation.  Ms. Cotting read the following                    
statement into the record:                                                     
                                                                               
"House Bill 464 amends Chapter 98, Session Laws of Alaska 1992.                
This special law of Alaska authorizes an Alaskan veterans' home and            
includes verbiage identifying domiciliary care.  However, in order             
for the state to recuperate approximately 65 percent of the                    
construction costs of the home from the Veteran's Administration,              
the law must include nursing facilities.  Without them, the state              
will have to shoulder the burden of all construction costs.                    
                                                                               
"Further, veterans' homes in other states are self sufficient in               
many cases because they contain nursing facilities.  The nursing               
facility allows the state to collect medical fees from Medicare,               
Medicaid, and other third party health insurance.  This offsets any            
state operating costs."                                                        
                                                                               
MS. COTTING noted that many of the veterans are out-of-state at                
another meeting, so they couldn't be in attendance to testify on               
the bill.  She noted that she is not an expert on the details of               
the legislation.                                                               
                                                                               
Number 2021                                                                    
                                                                               
REPRESENTATIVE JOULE indicated there is a huge fiscal note.                    
                                                                               
CHAIR MASEK stated that she assumes the bill will pick up another              
committee of referral.                                                         
                                                                               
REPRESENTATIVE JOULE referred to medical care for veterans and                 
asked if there is currently an arrangement with the hospitals                  
around the state where the veterans can get their medical                      
conditions taken care of.                                                      
                                                                               
MS. COTTING explained she does not know the answer to the question,            
but would defer to anyone who does.                                            
                                                                               
Number 2062                                                                    
                                                                               
REPRESENTATIVE RYAN stated, "A facility would establish a Medicaid             
number with the Medicaid portion of our health, education and                  
social service.  And they would submit a claim of code - proper                
authorized codes, and then they would argue whether they're going              
to get paid.  Not all payments are as speedy - as expedited as they            
should, but eventually they sort things out and the payment comes              
considering the service provided, what particular service it was               
and what the eligibility of the recipient was.  It is pretty much              
straight forward.  They're the same as the hospital or anybody else            
would bill.  I'll give you a small conflict on this, my wife is a              
registered nurse and works in nursing facilities.  In case anybody             
- there's a conflict there I'm declaring.  It's generally similar              
to a nursing home, long-term care facility if you have the nursing             
services available.  People who have to have medical procedures or             
nursing care would come under regular insurance and/or whatever                
their eligibility would be.  The Veteran's Administration (VA) --              
adds a coverage for these people they would be reimbursed through,             
however that was with the VA."                                                 
                                                                               
Number 2118                                                                    
                                                                               
REPRESENTATIVE JOULE said there is nursing care facility for the               
elderly in Kotzebue.  He said if a new veterans' facility was                  
constructed, would those people in Kotzebue have to the use the new            
facility first, wherever it was located rather than the one in                 
their home community.                                                          
                                                                               
REPRESENTATIVE RYAN said his knowledge of the actual veterans' care            
facility is some years dated, but the last time he was aware, since            
they did not have a veterans' facility in the state, most                      
facilities that offered medical care were eligible to provide care             
to veterans and be reimbursed by the VA.  He referred to a military            
hospital (indisc.) in Fort Wainwright and said he is not sure if               
the one at Elmendorf provides the same thing, but he knows that                
private medical facilities also had that ability because evidently             
the federal government didn't want to incur the cost putting a                 
facility in Alaska.  It is just a lot easier to use the existing               
facilities and to pay for the care.                                            
                                                                               
Number 2183                                                                    
                                                                               
JAMES L. KOHN, Director, Division of Alaska Longevity Programs,                
Department of Administration, came before the committee.  He noted             
he is the author of the fiscal note.  He explained the information             
that Representative Ryan discussed is correct.  Mr. Kohn read the              
following paragraph out of letter from Senator Murkowski with                  
regard to the possible construction of a VA home in the state of               
Alaska:                                                                        
                                                                               
"We should also realize that we have VA community nursing home                 
program now.  It obligates the federal government to pay the total             
cost of care of veterans that the VA places in community nursing               
homes.  We need to realize that after the home is opened, if the               
home was established, we will be exchanging some of that federal               
money for state obligations and it will not be on a one to one                 
trade, in fact it's nowhere near a one to one trade."                          
                                                                               
MR. KOHN said if a veteran has a long-term care need and is                    
eligible, they're able to enter their community program, the                   
Veteran's [Administration] are at this time obligated to pay those             
total costs.  If you build a veterans' home in North Pole and you              
live in Ketchikan, you'll have to go to North Pole to get that kind            
of care.                                                                       
                                                                               
Number 2263                                                                    
                                                                               
REPRESENTATIVE JOULE indicated he knows some of the veterans who               
are at the senior facilities.  He said, "They want to be close to              
home because they're in their -- you know, that's about as close as            
they can get, if they're from the villages, to their family.  And              
they're not going to be around much longer and to be totally some              
place else -- I know this sounds kind of cruel, but to die alone is            
a lonely thing.  In terms of -- they're getting care currently                 
under this current system.  This is not broken.  What are we                   
doing?"                                                                        
                                                                               
MS. COTTING said the bill was introduced as a direct response to a             
response by the Veteran's Association.  She said since they are not            
in attendance to present their rationale, she can't speak for them.            
She noted that she believes there is a compromise that is currently            
being worked on.  She said pointed out that the next committee of              
referral is the House State Affairs Committee that Representative              
James chairs.  Ms. Cotting stated, "If it's possible to move this              
out and then anybody who has watched State Affairs the last few                
years knows it will get a thorough hearing in there.  It won't get             
rushed through.  I think the sponsor of the bill, Representative               
James, would give it a good hearing in State Affairs.  If the                  
committee would care to move it on out since we don't know when                
you'll be meeting again, that might be an option.  Granted, the                
bill is flawed as it is and there needs to be a lot more work on               
it."  She said Representative Joule's point is true in that it                 
would be terrible to take people away from their homes in their                
last years.                                                                    
                                                                               
Number 2344                                                                    
                                                                               
REPRESENTATIVE RYAN stated he agrees with Representative Joule.  He            
said we have a unique situation in Alaska and they don't do this               
anywhere else.  He discussed the hardship of uprooting people that             
would have to move to the home.                                                
                                                                               
Number 2379                                                                    
                                                                               
REPRESENTATIVE MULDER said he believes that there are quite a few              
good reasons for considering the bill.  He said, "I probably would             
advocate that we just turn a blind eye at this point in time                   
towards the fiscal note because certainly the $10 oil, most things             
with fiscal notes has pretty though scrutiny up in Finance right               
now.  But look just at the merits of the issue and I think that                
we've raised some concerns today, but I think there are also some              
merits to it in terms of the focus and attention that are placed on            
veterans by VA homes and domiciliary.  So with that, Madam                     
Chairman, I would move that we pass [HB] 464 along to State                    
Affairs, knowing it will pick up a Finance referral as well, and               
along with its accompanying fiscal notes and individual                        
recommendations."                                                              
                                                                               
CHAIR MASEK asked if there was an objection.  Hearing none, HB 464             
was moved out of the House Special Committee on Military and                   
Veterans' Affairs.