Legislature(2025 - 2026)BUTROVICH 205
02/06/2025 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation(s): Healtheconnect Alaska's Health Information Exchange (hie) | |
| SB76 | |
| SB44 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | SB 76 | TELECONFERENCED | |
| += | SB 44 | TELECONFERENCED | |
SB 76-COMPLEX CARE RESIDENTIAL HOMES
3:58:51 PM
CHAIR DUNBAR reconvened the meeting and announced the
consideration of SENATE BILL NO. 76 "An Act relating to complex
care residential homes; and providing for an effective date."
3:59:24 PM
HEIDI HEDBERG, Commissioner, Department of Health, Anchorage,
Alaska, provided an opening statement on SB 76 on behalf of the
administration. She expressed appreciation to the committee for
hearing SB 76, introduced at the governor's request. She said
the bill resulted from collaboration between the Department of
Family and Community Services and the Department of Health to
address gaps in Alaska's system of care for individuals with
complex behavioral health and co-occurring needs. She stated
Alaska lacks an appropriate setting for these individuals to
receive care in a home-like, community-based environment. She
said the proposed new license type will fill this critical gap
and improve health outcomes for Alaskans.
4:00:36 PM
EMILY RICCI, Deputy Commissioner, Department of Health,
Anchorage, Alaska, co-presented an introduction on SB 76 and
provided the sectional analysis on behalf of the administration.
She moved to slide 2 and said the bill will help address and
identify gaps in the system of care for individuals with complex
needs. She recalled that strengthening the behavioral health
system, with a focus on complex care, was one of the
department's four key priorities. She emphasized the importance
of addressing needs at both the individual and systems levels.
She stated the bill reflects the outcome of that effort and the
department's collaboration with the Department of Family and
Community Services.
4:01:20 PM
CLINTON LASLEY, Deputy Commissioner, Department of Family and
Community Services, Juneau, Alaska, co-presented an introduction
on SB 76 on behalf of the administration. He moved to slide 3
and said the bill resulted from collaboration between the
Department of Health and the Department of Family and Community
Services, demonstrating that cooperation continued after the
departments split two and a half years ago. He stated the
Department of Family and Community Services prioritized
individuals with complex and co-occurring needs, creating a
Coordinated Health and Complex Care Team. He explained that work
included forming a case response team to address placement
challenges for youth and adults after treatment and holding
quarterly complex care committee meetings with the Department of
Health to address system-level gaps. He said this bill emerged
from those combined efforts.
4:03:16 PM
MR. LASLEY stated that complex care involves individuals with
complex needs who require a multidisciplinary team to determine
diagnoses, develop treatment outcomes, and identify necessary
resources. He explained that these individuals often have
behavioral challenges and need specialized care settings. He
emphasized that the goal is to improve their quality of life and
support independent living.
4:04:00 PM
MR. LASLEY moved to slide 4 and explained that the team
previously presented the complexity of individuals receiving
care, emphasizing a person-centered approach. He stated that
these individuals often require a multidisciplinary team because
they interact with multiple systems, including mental health
care, substance use treatment, social services, public safety,
and medical care. He noted that although this population is
relatively small, they demand a significant share of time and
resources due to frequent cycling through systems. He concluded
that current care settings, such as assisted living homes, often
lack the capacity to meet these individuals' needs, highlighting
the need for more specialized, long-term care options.
MR. LASLEY stated that many individuals requiring complex care
have histories of out-of-state treatment and display disruptive
or aggressive behaviors, often linked to co-occurring medical
conditions or dementia-related symptoms. He noted that such
behaviors, including advanced or sexualized conduct, are
difficult to manage in large facilities like Pioneer Homes
operated by the Department of Family and Community Services. He
emphasized that smaller, home-like settings could better provide
the specialized care needed while also protecting other
residents. He concluded that creating a complex care residential
home license type is essential to strengthening the continuum of
care in Alaska and supporting individuals in the least
restrictive environment possible.
4:06:52 PM
MS. RICCI moved to slide 5, What Does SB 76 Do, and stated that
SB 76 establishes the statutory framework needed for the
Department of Health to license and regulate a new type of
facility called complex care residential homes. She explained
that the goal is to create small, home-like community settings
designed to meet the complex needs of individuals through
multidisciplinary support. These homes would offer appropriate
staffing levels and specialized services tailored to the
population served. She added that various complex care
residential homes could be designed to address different needs
within this population
4:07:56 PM
MS. RICCI moved to slide 6, CCRHs Fill a Gap in the Care
Continuum, and explained the current continuum of care and how
complex care residential homes would fill a gap between acute
inpatient settings and lower-level community-based care. She
described the right side of the continuum as including inpatient
psychiatric hospitals, general acute hospitals, residential
psychiatric treatment centers for youth, and skilled nursing
facilities. The left side includes foster homes, private
residences, and assisted living homes, primarily supported
through Medicaid's home and community-based waiver services. She
noted that individuals with complex needs who do not qualify for
an intellectual and developmental disability diagnosis often
fall between these levels of care, making it difficult to access
appropriate services. She emphasized that complex care
residential homes are intended to bridge this gap by providing a
long-term, home-like setting tailored to these individuals'
needs.
4:09:41 PM
MS. RICCI moved to slide 7, Establishing a New Residential
Setting, and outlined a four-step approach used to develop a new
care model. The steps include identifying individual needs,
determining appropriate care settings, defining the services
required, and establishing funding mechanisms. She stated that
SB 76 addresses the second step: creating a setting where
individuals with complex needs can receive care. She clarified
that while the Department of Health already has the statutory
authority to develop services and funding, it lacks the
authority to create a new facility type, which SB 76 aims to
establish. She added that work on the remaining steps is
ongoing, but the bill is specifically focused on authorizing a
new license type for complex care residential homes.
4:11:13 PM
ROBERT LAWRENCE, MD, Chief Medical Officer, Department of
Health, Anchorage, Alaska, co-presented an introduction on SB 76
on behalf of the administration. He moved to slide 8, Who Would
Benefit from CCRHs, and stated that the slide emphasizes the
need to broaden the understanding of who could benefit from the
proposed facility type, noting that the goal is to design a
license that applies across a range of ages and mental health
conditions. He described the gap in care for youth, particularly
ages eight to twelve, who complete inpatient treatment but lack
safe or appropriate placement options, such as foster care or
assisted living. He also described older adults, including those
with dementia who end up in hospitals or even correctional
facilities, as another group lacking appropriate residential
care settings. He stressed the need for a community-based
facility that can serve various individuals with complex
behavioral health needs in a least restrictive environment.
4:13:12 PM
DR. LAWRENCE moved to slide 9, Key Features of a CCRH, and
explained that SB 76 is designed to be flexible and apply to
diverse age groups and needs. He noted that the proposed
legislation allows for licensing of facilities with fewer than
15 residents, with the expectation that youth homes would house
far fewertypically five or six. He added that the facilities
would operate with 24/7 staff support from a multidisciplinary
team tailored to the specific needs of the residents. He
emphasized that these homes would offer a higher level of
support than assisted living but remain less restrictive than
inpatient psychiatric settings. Each home would be defined by
its residents' individualized treatment plans, including
specialized monitoring and interventions.
4:14:35 PM
DR. LAWRENCE moved to slide 10, Benefits of a CCRH, and stated
that the benefits of establishing these home-like settings
include improving care for Alaskans with complex needs without
relying on overly restrictive environments. He explained that
the bill adds a new license type for clinically appropriate
residential settings and enables the development of specialized
services through regulation. He concluded by emphasizing that
this model enhances community safety in a compassionate, cost-
effective manner by providing tailored care in the least
restrictive environment.
4:15:40 PM
CHAIR DUNBAR stated that he had heard strong support for the
concept, noting that many see it as a valuable step-down option
to transition individuals out of inappropriate facilities. He
commented that the model echoes aspects of de-
institutionalization policies from decades ago, with a focus on
much smaller residential settings. He then asked whether the
proposed license type is intended to be flexible enough to serve
a wide range of individualsfrom children placed out of state to
seniors exiting the correctional systemor if it would allow for
specialized facilities within that license type to serve
distinct populations.
4:16:50 PM
MS. RICCI responded that the Department envisions specialized
homes rather than mixed-population facilities, noting that
although the term "complex care population" is used broadly,
there are clearly distinct subgroups with differing needs. She
gave the example of seniors with dementia and co-occurring
conditions like schizophrenia or aggressive behavior, whose care
needs differ significantly from youth returning from out-of-
state treatment. She explained that the intention is to create
separate homes tailored to specific populations. She added that
aligning building regulations with existing facility types
provides the state flexibility to adapt over time, allowing
requirements to be updated through regulation as population
needs evolve.
4:18:35 PM
MS. RICCI moved to slides 11 -13 and reviewed the sectional
analysis for SB 76:
[Original punctuation provided.]
SECTIONAL ANALYSIS
Senate Bill 76: Complex Care Residential Homes
Section 1. Amends AS 47.32.010(b) to add "complex care
residential homes" to the list of entities
regulated by the Department of Health.
Section 2. Amends AS 47.32.900(2) to update the
definition of "assisted living home" to
exclude complex care residential homes.
4:19:15 PM
MS. RICCI stated that the department is trying to delineate in
statute the difference between assisted living homes and complex
care residential homes. Assisted living homes are not meant to
serve individuals under the age of 18 and do not have the
multidisciplinary focus that is envisioned for complex care
residential homes.
Section 3. Adds AS 47.32.900(11) to modify the
definition of "hospital" to clarify that it
does not include complex care residential
homes.
4:19:30 PM
MS. RICCI said this ensures that hospital or facility
requirements are not applied to complex care residential homes
and emphasizes the focus on a home-like setting.
Section 4. Adds AS 47.32.900(22) to introduce a new
definition for "complex care residential
home." It is defined as a residential
setting that provides 24-hour multi-
disciplinary care on a continuing basis for
up to 15 individuals with mental,
behavioral, medical, or disability-related
needs requiring specialized care, services
and monitoring.
4:20:17 PM
MS. RICCI noted that the 15-bed limit aligns with a federal
requirement. She explained that the Department is mindful of
current and potential future federal rules as services and
funding mechanisms are developed. At the federal level, she
highlighted a prohibition on Medicaid coverage for institutions
of mental disease, with an exemption available for facilities
with 15 beds or fewer.
Section 5. Amends the uncodified law by adding a new
section that requires the Department of
Health to submit for approval by the United
States Department of Health and Human
Services amendments to the state Medicaid
plan or apply for waivers necessary to
implement the provisions of Sections 1-4.
Section 6. Amends the uncodified law by adding a new
section specifying that sections 1-4 of the
bill will only take effect if the United
States Department of Health and Human
Services approves the required Medicaid
waivers or amendments by July 1, 2031. The
commissioner of health is required to notify
the revisor of statutes within 30 days once
the necessary approvals are received.
Section 7. Provides that sections 1-4 take effect the
day after the United States Department of
Health and Human Services approves
amendments to the state plan or waivers
submitted under Section 5.
4:21:51 PM
MS. RICCI concluded the presentation.
4:22:05 PM
SENATOR GIESSEL asked where the Department would find staff for
the complex care residential homes.
4:22:15 PM
MS. RICCI responded that workforce challenges exist across
nearly all healthcare settings in the state and acknowledged
that the Department does not yet have all the answers. She
explained that many individuals with complex needs are already
receiving care in various settingssuch as assisted living
homes, inpatient facilities, or through the general relief
programbut without the appropriate alignment of services,
settings, and payment structures. She emphasized that staffing
difficulties are closely tied to inadequate funding models that
fail to reflect the intensity and acuity of care required. She
stated that aligning payment with the severity of need, service
complexity, and necessary staffing ratios is essential to
supporting and sustaining an appropriate workforce for complex
care residential homes.
4:24:08 PM
SENATOR GIESSEL stated that she is aware personnel costs will be
50 percent federally funded, as noted in the fiscal notes. She
expressed interest in the timeline for revising behavioral
health reimbursement rates and emphasized the importance of
completing that process before staffing begins. She noted that
staff in complex care residential homes will likely require
competitive compensation, given the intensity of care, and
stressed the need for an appropriate pay scale.
4:24:47 PM
MS. RICCI stated that rebasing for community behavioral health
rates took effect earlier this year. She added that the
Department is currently conducting a rate methodology review to
evaluate whether behavioral health payment rates and rules align
with service needs. She emphasized that the Department is
actively responding to concerns from the behavioral health
community about significant gaps between service demands and the
payment structures available to support them.
4:25:38 PM
CHAIR DUNBAR held SB 76 in committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 76 Presentation SHSS_2025.02.06.pdf |
SFIN 4/10/2025 9:00:00 AM SHSS 2/6/2025 3:30:00 PM |
SB 76 |
| SB 76 Fiscal Note 3.pdf |
SHSS 2/6/2025 3:30:00 PM |
SB 76 |
| SB 76 Sectional Analysis Version A.pdf |
SFIN 4/10/2025 9:00:00 AM SHSS 2/6/2025 3:30:00 PM |
SB 76 |
| SB 76 Transmittal Letter.pdf |
SFIN 4/10/2025 9:00:00 AM SHSS 2/6/2025 3:30:00 PM |
SB 76 |
| SB 76 Fiscal Note 2.pdf |
SHSS 2/6/2025 3:30:00 PM |
SB 76 |
| SB 76 Version A.pdf |
SHSS 2/6/2025 3:30:00 PM |
SB 76 |
| SB 76 Bill Summary Version A.pdf |
SFIN 4/10/2025 9:00:00 AM SHSS 2/6/2025 3:30:00 PM |
SB 76 |
| SB 76 Fiscal Note 1.pdf |
SHSS 2/6/2025 3:30:00 PM |
SB 76 |
| SHSS responses from 1.28.25 SB 44 Hearing.pdf |
SHSS 2/6/2025 3:30:00 PM |
SB 44 |
| HealthEConnect Senate HSS Committee Presentation_2-6-25.pdf |
SHSS 2/6/2025 3:30:00 PM |
HealthEConnnect |
| SB 44 SHSS responses Hearing 1.28.25.pdf |
SHSS 2/6/2025 3:30:00 PM |
SB 44 |
| SB 44 SHSS CS Version N 2.5.25.pdf |
SHSS 2/6/2025 3:30:00 PM |
SB 44 |
| SB 44 Explanation of Changes Version A to Version N 2.5.25.pdf |
SHSS 2/6/2025 3:30:00 PM |
SB 44 |
| SB 76 LoS Foundation Health Partners 2.6.25.pdf |
SHSS 2/6/2025 3:30:00 PM SHSS 2/13/2025 3:30:00 PM |
SB 76 |