03/09/1994 01:55 PM Senate HES

 SENATOR SHARP introduced  SB 249  (REGULATION OF ASSISTED LIVING              
 HOMES) as the next order of business before the committee.                    
 SENATOR LEMAN moved to adopt for discussion the CSSB 249 (HES), the           
 Lauterbach J version.  Hearing no objections, it was adopted.                 
                                                                               
 CONNIE SIPE, Executive Director of the Division of Senior Services,           
 stated that the CS appears consistent with their recommendations              
 and the committee's recommendations.                                          
                                                                               
 SENATOR LEMAN asked if Ms. Sipe was aware of the Anchorage Pioneer            
 Home's desire to be excluded from SB 249.                                     
                                                                               
 CONNIE SIPE said that she was aware of the Anchorage Pioneer Home's           
 position.  She explained that some of the nurses of the Anchorage             
 Pioneer Home seem to be concerned about the gradual shift in                  
 Pioneer Homes having more assisted living beds with fewer                     
 residential and nursing home beds.  They are also concerned that              
 unlicensed staff would be used in pioneer homes to provide nursing            
 care.  She referred to the health related services portion of                 
 SB 249 which allows a registered nurse to train an unlicensed                 
 individual to perform tasks as approved by the State Board of                 
 Nursing.  She explained that the nurses are confused because the              
 State Board of Nursing, who have the legal power to define the                
 scope and practice of nursing in the state, issued an opinion that            
 goes beyond SB 249.  The State Board of Nursing issued an opinion             
 stating that nurses may train and delegate tasks to unlicensed                
 personnel in any setting.  This position reverses a 1991 opinion.             
 She specified that the State Board of Nursing 1994 opinion, which             
 is currently in effect, has nothing to do with SB 249.  The opinion           
 relates to all nursing practice in the state of Alaska.  She                  
 asserted that SB 249 does not require the state of Alaska to do               
 assisted living in the Pioneer Homes, SB 249 only licenses what is            
 currently being done and allows it to be done in other settings               
 besides the Pioneer Homes.                                                    
                                                                               
 Number 306                                                                    
                                                                               
 DAVE WILLIAMS, Division of Medical Assistance in the Department of            
 Health and Social Services, reviewed the reasons an assisted living           
 facility which can offer medical services was created.  He pointed            
 out that assisted living facilities will increase access to                   
 services for which Medicaid will pay.  The alternative to assisted            
 living facilities would be nursing homes which are more expensive.            
 Assisted living facilities and pioneer homes would be considerably            
 less.  SB 249 increases access which would increase costs.                    
                                                                               
 Mr. Williams explained that the fiscal note assumes that a                    
 certificate of need would be required prior to conversion of any or           
 part of any assisted living facility into a nursing home.  He                 
 pointed out that the CS work draft left out some essential                    
 suggested language; the words "Not withstanding the expenditure               
 threshold" were left out at the beginning of section 4 on page 27.            
 He explained that someone should not be able to spend $1 million to           
 convert a building into a nursing home when the building is already           
 built, only the new license is needed to convert.  He stated that             
 the fiscal note would not be valid without that language because              
 conversion to a nursing home carries a $78,000 yearly cost.                   
                                                                               
 SENATOR ELLIS asked why those words were left out of the work                 
 draft.                                                                        
                                                                               
 CONNIE SIPE said that she read section 4 as stating that no part of           
 the building may be converted without a certificate of need.  She             
 explained that the drafter may have felt that the language was                
 strong enough legal language so that "regardless of the expenditure           
 limit" was not necessary.  She believed that putting the language             
 in would not hurt the bill.                                                   
                                                                               
 DAVE WILLIAMS explained that perhaps Lauterbach was being                     
 economical with words.  He reiterated the need to have that                   
 language added, especially on a technical level.                              
                                                                               
 Number 392                                                                    
                                                                               
 SENATOR ELLIS recommended that Mr. Williams' concerns should be               
 addressed before the bill moves out of the committee.  He asked for           
 the number of seniors who qualify under Medicaid waivers now and              
 how many people to date have been served.                                     
                                                                               
 DAVE WILLIAMS clarified that the waivers come in a graduated scale            
 over the next three years.  In the third year, this would come into           
 effect due to the time for an assisted living home to be built.  He           
 stated that 401 people could be served under the Aged Person                  
 Waiver.                                                                       
                                                                               
 CONNIE SIPE stated that nine seniors are being served.  There are             
 forty-five slots reserved.  She explained that by the end of this             
 fiscal year the half year mark would be reached, sixty people.  She           
 noted that the program was six months late because the regulations            
 were in the Department of Law longer than expected.                           
                                                                               
 SENATOR ELLIS asked if the Hickel administration had considered any           
 initiative making the Pioneer Homes Medicaid eligible.                        
                                                                               
 NANCY USERA, Commissioner of the Department of Administration,                
 explained that the subject of Medicaid has often been a topic of              
 discussion regarding maintaining the quality of service of Pioneer            
 Homes in a cost effective manner.  The people eligible for Medicaid           
 in the Pioneer Homes are few under the current structure.  If                 
 individuals are Medicaid eligible, there are private nursing                  
 facilities available for them.  She stated that the Pioneer Homes             
 fulfill the moderate income seniors and alzheimers disease or                 
 related dementia seniors, who are not Medicaid eligible.  She said            
 that they are not pursuing an initiative to make Pioneer Homes                
 Medicaid eligible.                                                            
                                                                               
 SENATOR ELLIS asked if poor individuals would go to private nursing           
 homes, while wealthy individuals would go to Pioneer Homes.  NANCY            
 USERA said that Pioneer Home residents cross the spectrum of the              
 senior community.  She discussed the change in the Pioneer Homes'             
 population, they do not need twenty-four hour nursing but rather              
 they need the assisted living type of situation.  Alzheimers is not           
 a Medicaid eligible diagnosis so currently, there is no funding for           
 them.  She reiterated that the Pioneer Homes serve a moderate                 
 income level population.                                                      
                                                                               
 SENATOR ELLIS inquired as to what level of the administration was             
 the decision made not to pursue an initiative to make Pioneer Homes           
 Medicaid eligible.  NANCY USERA explained that for the past three             
 years the administration has explored, with consideration to budget           
 concerns, how to maintain the financing structure of the Pioneer              
 Homes.  The benefits of making Pioneer Homes Medicaid eligible do             
 not out weigh the costs.                                                      
                                                                               
 SENATOR ELLIS pointed out that the rates of the Pioneer Homes have            
 been increasing which indicates, to him, the need to bring in more            
 money in order to lessen the general fund obligation.  He stated              
 that there was a lack of consistency.                                         
                                                                               
 NANCY USERA explained that to convert to a Medicaid system would              
 require significant structural changes to the Pioneer Home.  The              
 rates are adjusted on an annual basis with respect to the cost of             
 living in order to keep up with the additional cost of running the            
 homes.  She noted that Pioneer Home residents only pay 13 percent             
 of the cost of nursing, they pay 23 percent with assisted living,             
 and 35 percent with residential.  She said that these rates are not           
 unreasonable.  She believed that the residents are still receiving            
 the best deal in Alaska in terms of quality of care at the price.             
 SENATOR ELLIS disagreed with Ms. Usera on the issue that SB 249 has           
 nothing to do with Pioneer Homes regarding rates and such.                    
                                                                               
 Number 492                                                                    
                                                                               
 DAVE WILLIAMS referred to a 1990 December Report which illustrates            
 the avoidance of approximately 200 nursing home constructions by              
 emphasizing home rather than institutional care.  Since the current           
 facilities are full, waivers should be acquired and used as well as           
 going forward with assisted living homes.  He asserted that unless            
 those alternatives were utilized, nursing homes would be                      
 constructed.  Such circumstances would leave Medicaid responsible             
 for paying for the nursing homes.                                             
                                                                               
 SENATOR SHARP asked if Mr. Williams was referring to section C                
 regarding the omitted language.  DAVE WILLIAMS said no and                    
 specified that the language was omitted in the work draft on page             
 27, line 11 after subsection (b).  He reiterated his recommendation           
 to insert the language, "Not withstanding the expenditure threshold           
 in AS 18.07.031," at the beginning of subsection (b), before "A."             
                                                                               
                                                                               
 SENATOR SALO moved to adopt Mr. Williams suggestion.                          
                                                                               
 Page 27, line 11, after "(b)":                                                
  Insert "Not withstanding the expenditure threshold in AS                     
  18.07.031,"                                                                  
                                                                               
 Hearing no objections, it was adopted.                                        
                                                                               
 MARY LOU MIENERS, Chairperson of the State Legislative Committee              
 (SLC) for American Association of Retired Persons (AARP), stated              
 their support for SB 249.  She envisioned this as an opportunity to           
 assist seniors in their communities on a smaller scale.  She urged            
 passage of SB 249.                                                            
                                                                               
 SENATOR DUNCAN moved CSSB 249 (HES) as amended out of committee               
 with individual recommendations and the accompanying fiscal note.             
 Hearing no objections, it was so ordered.