Legislature(2005 - 2006)

05/10/2005 08:39 AM 125


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08:39:43 AM Start
08:46:38 AM SB125
09:19:24 AM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
          SB 125-LICENSING MEDICAL OR CARE FACILITIES                                                                       
                                                                                                                                
CHAIR DYSON  said that the  House adopted some amendments  to the                                                               
original  bill that  are  a valuable  step  toward resolving  the                                                               
disagreement between the House and  the Senate. He moved to adopt                                                               
HCS CSSB 125(FIN)  am H, version S.A, as  the committee's working                                                               
document.                                                                                                                       
                                                                                                                                
REPRESENTATIVE GARA asked if that  is the version that passed the                                                               
House.                                                                                                                          
                                                                                                                                
CHAIR DYSON  replied yes. There  were no objections and  HCS CSSB
125(FIN) am H, version S.A was adopted.                                                                                         
                                                                                                                                
SENATOR DAVIS  said that  some amendments  were approved  and not                                                               
approved by the  Department of Health and  Social Services (DHSS)                                                               
and  she wanted  a representative  from the  DHSS to  explain why                                                               
they disagreed on some amendments.                                                                                              
                                                                                                                                
8:46:38 AM                                                                                                                    
DR.  RICHARD  MANDSAGER,  Director, Division  of  Public  Health,                                                               
explained  that the  House Finance  Committee amendments  limited                                                               
background checks for  people and added a  requirement to exclude                                                               
information that was not germane on a registry.                                                                                 
                                                                                                                                
STEVE  ASHMAN,  Director,  Division of  Senior  and  Disabilities                                                               
Services, Department  of Health and Social  Services (DHSS), said                                                               
reversing senior services funds  was unacceptable. The department                                                               
agreed to restore funding to  clients with 300 percent of poverty                                                               
income if  the money was used  as a contribution towards  cost of                                                               
care.                                                                                                                           
                                                                                                                                
REPRESENTATIVE GARA said he aggress  with the compromise with one                                                               
exception.  He  wanted the  department  to  promise him  that  if                                                               
assisted living homes are right and  the transfer of funds is not                                                               
legal  and Medicaid  comes after  them for  the money,  the state                                                               
will cover them.                                                                                                                
                                                                                                                                
MR. ASHMAN  responded that a  Department of Law opinion  says the                                                               
amendment meets legal standards.                                                                                                
                                                                                                                                
REPRESENTATIVE GARA  replied that he  has no  doubt that it  is a                                                               
sound legal opinion, but he still had concerns.                                                                                 
                                                                                                                                
STACIE  KRALY,  Civil  Division,  Department of  Law,  said  that                                                               
auditors would  use the guidelines  for assisted living  homes to                                                               
determine how those funds would  be addressed. She indicated that                                                               
those costs cannot come back to the state.                                                                                      
                                                                                                                                
8:54:05 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MCGUIRE said  she  is concerned  that putting  an                                                               
assurance on paper is red-flagging a potential concern.                                                                         
                                                                                                                                
MS. KRALY agreed and said that was an astute observation.                                                                       
                                                                                                                                
REPRESENTATIVE GARA said that he  feels his question has not been                                                               
answered.  It seems to him  that if the state is telling assisted                                                               
living homes what  they are doing is legal, it  should be able to                                                               
say it will cover them.                                                                                                         
                                                                                                                                
MR.  ASHMAN responded  that the  state would  cover them  if they                                                               
acted on its legal opinion and advice.                                                                                          
                                                                                                                                
REPRESENTATIVE GARA  stated that  he disagreed on  this amendment                                                               
and would like to adopt different language.                                                                                     
                                                                                                                                
8:58:52 AM                                                                                                                    
                                                                                                                                
MR.  ASHMAN said  another concern  is that  although cheaper  and                                                               
less-skilled services  such as companion services  are beneficial                                                               
they would  require a big fiscal  note for the state.  He thought                                                               
it  would  be  prudent  to see  what  other  cheaper  alternative                                                               
services similar to those are available under Medicaid.                                                                         
                                                                                                                                
9:06:17 AM                                                                                                                    
                                                                                                                                
MR. ASHMAN said  it would cost the state $10  million in the next                                                               
fiscal  year  to  offer  companion  services  and  personal  care                                                               
attendants would be even more costly.                                                                                           
                                                                                                                                
CHAIR  DYSON  stated  most  services that  seniors  need  can  be                                                               
provided by non-medically trained staff.  He asked if the purpose                                                               
of  the bill  was  to attempt  to have  those  covered under  the                                                               
federal program.                                                                                                                
                                                                                                                                
JANET  CLARKE, Assistant  Commissioner, Division  of Finance  and                                                               
Management  Services, Department  of Health  and Social  Services                                                               
(DHSS), said  the department considers  companion services  to be                                                               
an expansion  of Medicaid.   The  department made  three changes.                                                               
One is for  a person to come  into a home to provide  care when a                                                               
client is  sleeping. This  would apply to  10% of  claimants. The                                                               
second is to provide coverage for  a person to provide care for a                                                               
patient who  is at work, which  would apply to 10%  of claimants.                                                               
The third is  to provide companion care in  places with medically                                                               
trained attendants.                                                                                                             
                                                                                                                                
CHAIR DYSON asked what the cost of the expansion would be.                                                                      
                                                                                                                                
MS. CLARKE replied  that it is expected to cost  $80 million next                                                               
year.                                                                                                                           
                                                                                                                                
REPRESENTATIVE  GARA  suggested  taking  Representative  Cissna's                                                               
amendment and adding  language saying that this  waiver shall not                                                               
be  implemented  and  benefits  shall   not  be  paid  until  the                                                               
department  adopts  regulations  after   completing  a  study  to                                                               
determine how to approach the problem in the future.                                                                            
                                                                                                                                
9:12:43 AM                                                                                                                    
                                                                                                                                
MR. ASHMAN said he did not favor that approach at this time.                                                                    
                                                                                                                                
CHAIR DYSON announced that the  committee would take up the three                                                               
House  floor amendments  at this  time. He  moved Amendment  1 to                                                               
delete House Floor Amendment 1.                                                                                                 
                                                                                                                                
                          AMENDMENT 1                                                                                       
                                                                                                                                
Offered by Representative Gara                                                                                                  
                                                                                                                                
Page 15, following line 29:                                                                                                     
 Insert new bill sections to read:                                                                                              
  "*Sec. 20. AS 47.07.070(a) is amended to read:                                                                              
     (a)Except as provided under (d) or (e) of this section, the                                                            
[THE] department shall, by regulation,  set rates of payments for                                                               
health  facilities  under this  chapter  and  AS 47.25.120  -  AS                                                               
47.25.300 in  accordance with 42  U.S.C. 1396 (Title  XIX, Social                                                               
Security  Act,  Medical  Assistance)  and this  section.  A  rate                                                               
established  under  this  section  takes effect  under  AS  44.62                                                               
(Administrative Procedure Act) but  not until approved in writing                                                               
by   the  commissioner.   The  commissioner   may  delegate   the                                                               
performance of these functions.                                                                                                 
  *Sec.21 AS  47.07.070 is amended  by adding new  subsections to                                                             
read:                                                                                                                           
     (d) For residential support living services provided to an                                                                 
eligible recipient  of medical assistance  living in  an assisted                                                               
living  home   licensed  under  AS   47.33,  the   minimum  daily                                                               
reimbursement  rate to  the  assisted living  home  for room  and                                                               
board expenses is $28.                                                                                                          
     (e) A calculation of the rate for administrative and                                                                       
general costs for a provider,  including an assisted living home,                                                               
shall  be  determined  in  the  same way  as  a  calculation  for                                                               
administrative and  general cost  rate for  a Pioneers'  Home. In                                                               
this subsection,  "administrative and general costs"  means those                                                               
expenses that are  common to the overall operation  of a provider                                                               
providing home  and community-based waiver services  and that are                                                               
not  directly assignable  to or  borne by  a specific  program or                                                               
recipient of a home and community-based service."                                                                               
                                                                                                                                
Renumber the following bill sections accordingly.                                                                               
                                                                                                                                
Page 40, following line 10:                                                                                                     
 Insert a new bill section to read:                                                                                             
  "*Sec.49. AS 47.07.070(c) is repealed."                                                                                     
                                                                                                                                
Renumber the following bill sections accordingly.                                                                               
                                                                                                                                
Page 40, following line 19:                                                                                                     
 Insert a new bill section to read:                                                                                             
  "*Sec.52. The uncodified law of  the State of Alaska is amended                                                               
by  adding a  new section  to read:  REGULATIONS ANNULLED.  7 AAC                                                               
43.1058(k)(1)(B) are annulled."                                                                                                 
                                                                                                                                
Renumber the following bill sections accordingly.                                                                               
                                                                                                                                
Page 45, line 18, following "Sections":                                                                                         
 Insert "20,21,49,52"                                                                                                           
                                                                                                                                
Renumber all  internal references to bill  sections in accordance                                                               
with this amendment.                                                                                                            
                                                                                                                                
REPRESENTATIVES GARA and  ANDERSON objected and a  roll call vote                                                               
was taken.  Representatives Anderson, McGuire  and Representative                                                               
Gara  voted  nay. Senator  Huggins  and  Chair Dyson  voted  yea;                                                               
Senators Davis voted nay; and Amendment 1 failed.                                                                               
                                                                                                                                
CHAIR DYSON moved Amendment 2 to delete House Floor Amendment 2.                                                                
                                                                                                                                
                          AMENDMENT 2                                                                                       
                                                                                                                                
Offered by Representative Cissna                                                                                                
                                                                                                                                
Page 41, following line 28:                                                                                                     
 Insert a new bill section to read:                                                                                             
  "*Sec.54. The uncodified law of  the State of Alaska is amended                                                             
by  adding  a new  section  to  read: MEDICAL  ASSISTANCE  WAIVER                                                               
APPROVAL; LEGISLATIVE INTENT.                                                                                                   
     (a) The Department of Health and Social Services shall                                                                     
proceed immediately  to seek federal  approval to amend  the home                                                               
and community based  waiver program for the  state under Medicaid                                                               
to  add  adult companion  services  for  older Alaskans  and  for                                                               
adults  with  physical  disabilities as  a  reimbursable  service                                                               
either as a separate service  or personal attendant services. The                                                               
services  may be  combined  only if  the  combination results  in                                                               
greater  efficiency  in administering  the  program  and is  more                                                               
beneficial to the recipient of waiver services.                                                                                 
     (b) It is the intent of the legislature to restore non-                                                                    
medical  care,  supervision  and socialization  provided  through                                                               
companion  services  to  functionally  impaired  adults  who  are                                                               
eligible for home and community  based waivers for older Alaskans                                                               
and  for adults  with physical  disabilities. Companion  services                                                               
were  formerly provided  as part  of respite  service before  the                                                               
amendments  to  7  AAC  43.1040.  Effective  May  15,  2004,  the                                                               
Department  of Health  and Social  Services  was prohibited  from                                                               
paying for respite services that  allow a primary caregiver of an                                                               
eligible recipient  to work under  7 AAC 43.049(d)(4)(A)  or that                                                               
are provided during sleeping or  nighttime hours. Adult companion                                                               
services  shall be  available under  this Act,  subject to  other                                                               
federal and  state limits,  as part  of the  recipient's approved                                                               
plan of  care to allow  a primary caregiver  to work, to  allow a                                                               
primary  caregiver to  sleep during  normal nighttime  hours when                                                               
the recipient of  care cannot be safely  left unsupervised during                                                               
the  caregivers'  sleep  hours,   and  to  allow  supervision  or                                                               
monitoring  of the  recipient  who is  not  otherwise safe  while                                                               
sleeping.  The  department  shall   enact  regulations  that  are                                                               
necessary  to   implement  the  legislative  intent   under  this                                                               
section.                                                                                                                        
     (c) In this section, "adult companion services" means non-                                                                 
medical  care,  supervision,  or   socialization  provided  to  a                                                               
functionally  impaired adult  in  accordance  with a  therapeutic                                                               
goal  in  the  recipient's  plan  of  care  under  the  home  and                                                               
community based waiver program;  for purposes of this subsection,                                                               
"therapeutic goal" means  a goal that has the  effect of delaying                                                               
or  avoiding placement  of the  recipient in  a more  restrictive                                                               
environment,  including  an assisted  living  home  or a  nursing                                                               
home,  and  that  supports  the   vital  needs  for  the  primary                                                               
caregiver of the recipient.                                                                                                     
                                                                                                                                
Renumber the following bill sections accordingly.                                                                               
                                                                                                                                
REPRESENTATIVE ANDERSON objected and a  roll call vote was taken.                                                               
Representatives Anderson,  McGuire and Representative  Gara voted                                                               
nay; Senator  Huggins and  Chair Dyson  voted yea;  Senator Davis                                                               
voted nay; and Amendment 2 failed.                                                                                              
                                                                                                                                
CHAIR DYSON moved Amendment 3 to delete House floor Amendment 3.                                                                
                                                                                                                                
                 AMENDMENT 3 (title amendment)                                                                              
                                                                                                                                
Offered by Representative Croft                                                                                                 
                                                                                                                                
Page 1, line 10, following "Services;"                                                                                        
 Insert "relating to public assistance  for health facilities and                                                             
assisted living  homes, to  rates charged  by an  assisted living                                                             
home, and  to the liability  of recipients of home  or community-                                                             
based services to pay for those services;"                                                                                    
                                                                                                                              
REPRESENTATIVE ANDERSON objected and a  roll call vote was taken.                                                               
Representatives Anderson,  McGuire and  Gara voted  nay; Senators                                                               
Huggins and Chair  Dyson voted yea; Senator Davis  voted nay; and                                                               
Amendment 3 failed.                                                                                                             
                                                                                                                                
CHAIR DYSON  moved that the  committee request limited  powers of                                                               
free  conference   to  continue   its  business  there   were  no                                                               
objections and it was so ordered.                                                                                               
                                                                                                                                
CHAIR DYSON adjourned the meeting at 9:19:24 AM.                                                                              

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