02/05/2002 03:04 PM House HES
| Audio | Topic |
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+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
February 5, 2002
3:04 p.m.
MEMBERS PRESENT
Representative Fred Dyson, Chair
Representative Peggy Wilson, Vice Chair
Representative John Coghill
Representative Gary Stevens
Representative Vic Kohring
Representative Sharon Cissna (via teleconference)
Representative Reggie Joule
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 309
"An Act relating to the Interstate Compact on Placement of
Children."
- HEARD AND HELD
HOUSE BILL NO. 366
"An Act relating to assisted living homes; and providing for an
effective date."
- HEARD AND HELD
EXECUTIVE ORDER 103
File Transfer to Archives
- EXECUTIVE ORDER ADVANCED
PREVIOUS ACTION
BILL: HB 309
SHORT TITLE:INTERSTATE PLACEMENT OF CHILDREN
SPONSOR(S): REPRESENTATIVE(S)CHENAULT
Jrn-Date Jrn-Page Action
01/14/02 1956 (H) PREFILE RELEASED 1/4/02
01/14/02 1956 (H) READ THE FIRST TIME -
REFERRALS
01/14/02 1956 (H) HES, JUD
01/14/02 1956 (H) REFERRED TO HES
01/29/02 (H) HES AT 3:00 PM CAPITOL 106
01/29/02 (H) -- Meeting Canceled --
01/30/02 2101 (H) COSPONSOR(S): DYSON
02/05/02 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 366
SHORT TITLE:RATES FOR ASSISTED LIVING FACILITIES
SPONSOR(S): REPRESENTATIVE(S)COGHILL
Jrn-Date Jrn-Page Action
01/30/02 2098 (H) READ THE FIRST TIME -
REFERRALS
01/30/02 2098 (H) HES, FIN
01/30/02 2098 (H) REFERRED TO HES
02/05/02 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
SUE WRIGHT, Staff
to Representative Mike Chenault
Alaska State Legislature
Capitol Building, Room 432
Juneau, Alaska 99801
POSITION STATEMENT: Testified on behalf of HB 309's sponsor,
Representative Chenault.
ELMER LINDSTROM, Deputy Commissioner
Department of Health & Social Services
P.O. Box 110601
Juneau, Alaska 99811-0601
POSITION STATEMENT: During hearing on HB 309, raised questions
pertaining to language about certified copies.
DOUG WOOLIVER, Administrative Attorney
Office of the Administrative Director
Alaska Court System
820 West Fourth Avenue
Anchorage, Alaska 99501-2005
POSITION STATEMENT: During hearing on HB 309, answered legal
questions pertaining to language contained therein.
THERESA TANOURY, Director
Division of Family & Youth Services
Department of Health & Social Services
P.O. Box 110630
Juneau, Alaska 99811-0630
POSITION STATEMENT: During hearing on HB 309, reported on DFYS
procedures followed in ICPC cases and the need for expediency in
such cases.
WES INGRUM, Partner
Cornerstone, LLC
2004 Parkview Circle
Anchorage, Alaska 99501
POSITION STATEMENT: During hearing on HB 366, stressed the
importance of stable funding for assisted-living-care providers.
MARY NICHOLSON
Nicholson Assisted Living
P.O. Box 2495
Kenai, Alaska 99611
POSITION STATEMENT: Testified in support of HB 366.
DEBBIE CASH, Owner-Operator
Debbie's Fireside Home
3291 Jefferson Drive
Fairbanks, Alaska 99709
POSITION STATEMENT: Testified in support of HB 366; delineated
the many costs incurred by assisted-living-home providers.
BOBBY CASH
1224 Ninth Avenue
Fairbanks, Alaska 99701
POSITION STATEMENT: During hearing on HB 366, expressed his
wish for reliable funding.
MONTA FAYE LANE, President
Assisted Living Association of Alaska
109 East Fifth
North Pole, Alaska 99705
POSITION STATEMENT: Testified in support of HB 366; gave a
history of funding for assisted-living-home facilities.
ACTION NARRATIVE
TAPE 02-5, SIDE A
Number 0001
CHAIR FRED DYSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:04 p.m.
Representatives Dyson, Wilson, Coghill, Stevens, and Cissna (via
teleconference) were present at the call to order.
Representatives Kohring and Joule arrived as the meeting was in
progress. [For minutes on the overview presentations by the
Substance Abuse Directors Association of Alaska and the
Association of Rural and Alaska Native Drug & Alcohol Programs,
see the 4:25 p.m. minutes for this date.]
HB 309-INTERSTATE PLACEMENT OF CHILDREN
Number 0152
CHAIR DYSON announced that the first order of business was HOUSE
BILL NO. 309, "An Act relating to the Interstate Compact on
Placement of Children."
Number 0176
SUE WRIGHT, Staff to Representative Mike Chenault, Alaska State
Legislature, testified on behalf of HB 309's sponsor,
Representative Chenault. House Bill 309 requires that specific
documentation, such as court orders or copies of custody orders,
be in place when children who are wards of the state are
transferred from one state to another, she explained. Ms.
Wright noted Section 2 of HB 309 and said, "An agreement under
this section must be in writing, and an original of the
agreement shall be held in the files of the department."
MS. WRIGHT indicated that a representative from the court system
was present who had brought to the sponsor's attention the fact
that originals must remain in the court files. She informed
members that a proposed committee substitute (CS) had been
prepared to address that issue. She said Section 3 of HB 309
increases the term of imprisonment for violation of the
[Interstate Compact on the Placement of Children (ICPC)]. She
noted her belief that the existing statute does not provide for
jail time, and she noted that the existing fine is $200. House
Bill 309 adds language which designates each day as a separate
and equal violation of the compact. She offered the example of
a child who is out of state for 10 days [in violation of the
compact]; the party responsible for this breach of the compact
could be sentenced to a $10,000 fine and 1,800 days in jail.
Number 0350
MS. WRIGHT explained that this severe penalty would force the
Division of Family & Youth Services (DFYS) to become more
accountable. She acknowledged that it was unlikely anyone would
ever serve jail time or pay the fine as the result of a
violation. She said, "In my experience, it's been horrific that
a child should ever be transferred without proper
documentation." She referenced cases presented to [the
sponsor's] office which indicated that children do get
transferred with incomplete documentation. She offered that she
didn't fault the department for this problem because
[caseworkers] have a difficult job. However, she expressed her
belief that everyone has laws and regulations with which he/she
must comply.
Number 0475
CHAIR DYSON noted his understanding that the proposed CS
requires certified copies instead of originals. He asked if
"certified copies" is a legal term.
MS. WRIGHT affirmed that "certified copies" is a legal term.
CHAIR DYSON noted that Doug Wooliver, Administrative Assistant,
Office of the Administrative Director, Alaska Court System, had
signaled his agreement.
Number 0503
REPRESENTATIVE WILSON moved to adopt the proposed CS [Version F,
22-LS1218\F, Lauterbach, 2/5/02].
Number 0530
REPRESENTATIVE COGHILL noted the violation language in HB 309
and asked Ms. Wright for the rationale behind the severity of
the penalties.
Number 0555
MS. WRIGHT responded by referring to a "blatant violation" of
the ICPC that occurred in August 2001. In this case, a child
was transferred out of Alaska without proper legal notice, she
said; the parties were notified on July 24 or 27, and the child
was transferred out of state on August 3. She indicated that
the child was slated to be transferred to Arizona as directed by
an unsigned court order; this meant that there was no
accompanying documentation with the child. The child was
instead taken to Portland, Oregon. The foster parents, who were
moving out of state under non-emergency circumstances, picked
the child up in Portland, and then took her to Arizona. Ms.
Wright noted that the transfer to Portland was a violation of
the ICPC.
Number 0659
REPRESENTATIVE COGHILL acknowledged that the aforementioned case
is "a tough and egregious example." He again requested the
rationale for the penalty provided in HB 309 for violation of
ICPC.
MS. WRIGHT responded that there is no accountability when the
compact is violated.
Number 0700
REPRESENTATIVE COGHILL emphasized that this would be "one of the
weightier things ... we'll discuss as a policy matter," and that
he wanted to know the rationale behind it.
Number 0706
CHAIR DYSON asked Ms. Wright if it was her belief that the
stronger penalty would motivate DFYS workers [to abide by the
compact].
MS. WRIGHT expressed her uncertainty that this would motivate
workers. She said, however, "It certainly would make me look
twice before I violated that compact."
Number 0761
CHAIR DYSON inquired if comparable penalties for administrative
personnel existed elsewhere in statute.
MS. WRIGHT replied that if she violated the law to the extent
the ICPC was violated, she would lose her job.
Number 0798
CHAIR DYSON reiterated his question about similar penalties
existing in state law.
Number 0820
MS. WRIGHT answered, "I would certainly think that in the
Department of Corrections, it would be comparable to selling
drugs in a prison."
CHAIR DYSON indicated that his question remained unanswered.
Number 0830
REPRESENTATIVE WILSON restated her motion to adopt Version F.
There being no objection, Version F was adopted.
Number 0913
ELMER LINDSTROM, Deputy Commissioner, Department of Health &
Social Services, noted that neither he nor the division director
had seen Version F prior to the hearing.
Number 0937
CHAIR DYSON commented that Version F changes only the required
documentation language from "originals" to "certified copies".
Number 0945
MR. LINDSTROM confirmed that this is also his understanding. He
offered that the language requiring an original copy was
regarded by the department as a "very serious barrier" and might
be a standard that could not be met. At the very least, it
would cause significant delays to the ICPC process. He
expressed his opinion that Version F is an improvement. He
noted his uncertainty regarding what "certified copies" means to
the department; he wishes to confer with legal counsel and [ICPC
personnel] to determine what it means. He stated that the bill
requires a number of documents to be included in the packet. He
indicated his uncertainty about which entity would actually
provide the certification of documents, the department or the
documents' source. He indicated that Version F does address the
department's original concerns with HB 309.
Number 1004
CHAIR DYSON asked Mr. Lindstrom how long this information-
gathering process would take.
MR. LINDSTROM replied that he could respond within two days'
time.
Number 1020
DOUG WOOLIVER, Administrative Attorney, Office of the
Administrative Director, Alaska Court System, stated that
"certified copies" means something specific to the court system.
He noted that the court system routinely certifies documents,
but he indicated that he didn't know what "certified copies"
means to the Department of Health & Social Services.
Number 1043
CHAIR DYSON asked who certifies documents, the sender or
receiver.
MR. WOOLIVER answered that in the court system, certified copies
of court records may be obtained from the clerk of court. He
stated that he couldn't speak to [the certification process] in
department records.
CHAIR DYSON inquired whether a certified copy could be faxed.
Number 1089
MR. WOOLIVER responded that he did not know if a document's
legal status would change if a certified copy was faxed.
CHAIR DYSON summarized that his understanding of the [intent of
HB 309] is ensuring that the correct documentation accompanies a
child who is transferred out of state. He also noted the
importance of expediting this transfer of paperwork.
Number 1111
ELMER LINDSTROM noted that his question pertaining to certified
copies does not include court documents, but pertains to the
department's certifying all documents. Medical and other
records not originating in the court system would be included in
the package. What would this certification process entail for
the department? If certification from a doctor was required, he
stated, it "might put us back in the same quandary that we had
with the original version."
MR. LINDSTROM noted that the department had no objection to the
criminal penalties [provided in HB 309], but he raised the
question of the penalties' application to private placements,
which are not within the department's purview. He added that
this might be a question for the Department of Law.
Number 1180
MR. LINDSTROM concluded by stating that the aforementioned case,
involving a child's out-of-state relocation, was not an ICPC
case at the time of transfer. The foster parents chose to
relocate. The case has since been designated as an ICPC matter.
Number 1219
REPRESENTATIVE COGHILL asked how documents in ICPC cases are
currently transferred by the department.
Number 1250
THERESA TANOURY, Director, Division of Family & Youth Services,
Department of Health & Social Services, replied that an overall
agreement exists among states included in the compact. When
children are moved across state boundaries, states use the same
forms and same supporting documentation. This documentation
includes psychological evaluations, home studies, and any
documentation that provides the receiving state with more
information about the child. She added that many times this
document transfer is done via fax to save time.
Number 1292
REPRESENTATIVE COGHILL indicated that [HB 309's intent] is to
ensure that paperwork be certified and part of that [ICPC]
agreement. He asked if required certification of the packet
would be more difficult before the relocation of a child.
Number 1317
MS. TANOURY responded that she thought it would be time-
consuming effort and would delay placement for children going
across state lines. Most of these children [leaving the state]
are bound for permanent, long-term placement with relatives. It
is currently a lengthy process, she noted.
Number 1345
REPRESENTATIVE CISSNA asked why these delays occur and whether
the punishment [in HB 309] fits the crime. She indicated that a
correction of the crime would be more appropriate. "Is overwork
... not part of the problem?" she asked.
Number 1401
MS. TANOURY replied that the aforementioned case would not have
fallen under the ICPC compact. She noted that DFYS delayed in
finding a placement with relatives. In the meantime, the child
bonded with her foster parents. She explained that it takes a
tremendous amount of time to find and obtain approval for
relatives. After the child bonds with foster parents, it is a
disruption to relocate the child to another placement. She
added, "Had we been able to turn the clock back for that child,
it would have been that we would've located relatives a lot
earlier ... and moved the child to a more permanent home while
... working with the parents ... on a permanent plan, to see if
they would have the child back."
Number 1483
REPRESENTATIVE CISSNA asked, "Why did it happen in the first
place?" She further asked whether the caseworker had adequate
time to solve the problem.
Number 1551
MS. TANOURY replied that the delay in locating relatives
occurred because of the large amount of activity early in the
case. Uncooperative parents do not readily provide information
on relatives who live Outside. Once located, relatives must
pass licensing requirements, and the receiving state must
approve the transfer. Currently, parents are required to
provide a list of relatives, but not until the adjudication
hearing 120 days after a child's removal. The division does ask
parents for a list of relatives before the adjudication hearing,
but some parents do not comply with this request.
Number 1560
CHAIR DYSON suggested that Representative Cissna was providing
Ms. Tanoury with an opportunity to highlight the need for more
staff and smaller caseloads.
REPRESENTATIVE WILSON asked whether foster parents are allowed
to move out of state at will without notifying DFYS.
MS. TANOURY replied, "No. They cannot move out of state at
will." She added that a review must take place, and rarely is a
move allowed. It is usually under a court order that a foster
child's out-of-state move is permitted.
Number 1587
REPRESENTATIVE WILSON asked if caseworkers in the aforementioned
case had prepared the proper paperwork before the child was
moved out of state.
MS. TANOURY answered that the court had ordered that the move
could occur; one or two days later, the child was taken out of
state. The objection was that the court order was not in hand
at the time of transfer. She stated that workers often do not
wait for original or certified documents; they implement the
court's order when it is given. Many times it takes four to six
weeks to get a signed court order.
Number 1625
REPRESENTATIVE WILSON said, "I assume, then, that they just
didn't know any better and took the child - either that or they
weren't told." She asked if DFYS now moves children out of
state without all the necessary paperwork.
Number 1650
MS. TANOURY replied that DFYS cannot allow a child to leave the
state for a permanent placement without the receiving state's
approval. The receiving state requires documentation that
includes faxed copies. The receiving state must complete a home
study of the proposed placement, which must be approved before
each state can send or receive the child. All of this must be
done beforehand, she explained. In response to Representative
Wilson's statement about the case in question, Ms. Tanoury
pointed out that DFYS had notified the foster parents of the
court's approval, so DFYS permitted the family to leave the
state with the child. The implementation occurred following the
court's approval but prior to receipt of the actual court order.
Number 1697
REPRESENTATIVE WILSON asked if the foster family was told they
needed to wait for paperwork.
MS. TANOURY responded that in many cases, DFYS does not wait for
the paperwork. The division implements the court's orders at
the time of the order. In the case in question, the caseworker
told the foster family to go ahead with the move, she stated.
Number 1733
REPRESENTATIVE WILSON asked for clarification.
MS. TANOURY restated that this case did not fall under the ICPC
compact. The compact applies to children leaving the state
alone for placement in a new home. She said, "This particular
situation was an intact family moving out of state, ... so it
didn't fall under the compact at all."
Number 1767
REPRESENTATIVE WILSON sought confirmation that foster parents
need permission to leave the state.
MS. TANOURY replied, "Just from us. ... We wouldn't let a foster
parent move with a child without telling us." She noted that in
cases where reunification is a goal, an out-of-state move would
be inappropriate. A foster family's move needs only the
approval of DFYS, she said.
Number 1831
CHAIR DYSON asked if DFYS retained jurisdiction of a child
placed in a family that relocated out of state.
MS. TANOURY answered that DFYS maintains jurisdiction while the
child is in another state. The state dismisses custody after an
adoption order takes place.
Number 1851
CHAIR DYSON inquired whether foster parents could move Outside
without court approval.
MS. TANOURY stated that this happens, but not very often.
Usually court approval is obtained, but it isn't necessary.
Number 1861
CHAIR DYSON sought confirmation that DFYS could approve a move.
In the aforementioned case, he noted that court approval was
obtained, but the family traveled without proof of the court
order.
MS. TANOURY affirmed that this was indeed the case.
CHAIR DYSON said, "So your perspective is that because the court
often takes so much time to get the paperwork ... done, ... you
often go ahead [with] doing what you hope is in the best
interest of the child ... based on the ... court's wishes, but
not necessarily having the piece of paper in your hand."
Number 1888
MS. TANOURY replied, "That's correct."
CHAIR DYSON asked, "Is that the way you want it to be?"
Number 1890
MS. TANOURY answered that she thought "things might move quicker
for kids if ... we didn't have to wait all the time." It is
easier for kids, she stated, if approval can be given verbally.
Number 1900
REPRESENTATIVE COGHILL asked whether holding the certified
papers in a state file was a significant problem and inquired
whether other states followed this practice. Does the state
currently keep compact records?
MS. TANOURY responded that she didn't know whether keeping the
files was a problem or what other states require. She stated
that she would get back to the members on this. The state
currently keeps the originals and sends faxes or copies to other
states. In many cases this takes a long time, she offered.
Number 1960
REPRESENTATIVE COGHILL asked if any language in the certified
agreement was in conflict with anything in the compact.
MS. TANOURY replied that she would have to check on this, since
she had just been given the proposed CS.
MR. LINDSTROM referenced the analysis of HB 309 prepared by the
secretariat to the Association of Administrators of the
Interstate Compact on the Placement of Children. The analysis
states that the initial wording of the bill relating to original
documents is in violation of the compact. When "certified copy"
is inserted for "original", Mr. Lindstrom noted, the violation
of the compact is still an open question.
Number 2020
REPRESENTATIVE JOULE noted that one issue [in the delay of
placement] is the length of time it takes to locate relatives.
He asked if DFYS is doing anything to address this.
Number 2043
MS. TANOURY stated that DFYS has done things internally to
address this issue. In Anchorage, a tribal help desk has been
established with the Cook Inlet Tribal [Council] to assist in
locating a child's tribe and then conferring with that tribe
regarding appropriate placement. She offered that the
governor's budget includes a position called a "relative
navigator" to help DFYS locate relatives and then assist the
relatives as they go through the system.
Number 2075
REPRESENTATIVE JOULE asked if this applies to any child in the
system.
MS. TANOURY replied, "That's correct." She added that
Representative Meyer might include language in a future bill
requiring parents to provide DFYS with a list of relatives at
the first hearing, rather than 120 days after removal.
Number 2101
REPRESENTATIVE JOULE asked whether other states require that
level of paperwork.
MS. TANOURY answered that she didn't know, but she could find
that out. The compact, she noted, ties Alaska to other states
in the agreements pertaining to how children move across state
lines. The compact does not require certified or original
documentation. She offered that a national dialogue is
addressing the matter of getting the ICPC process to move more
quickly. A state's conducting of a home study can be a lengthy
process, she added.
Number 2156
CHAIR DYSON suspended the hearing on HB 309 until February 7.
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
Alaska.
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
furnished.
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
IADLs.
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
services].
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
offered.
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.]
EXECUTIVE ORDER 103: FILE TRANSFER TO ARCHIVES
Number 1150
CHAIR DYSON announced the next order of business to be Executive
Order 103: File Transfer to Archives.
REPRESENTATIVE JOULE stated that EO 103 will go to House State
Affairs Standing Committee.
REPRESENTATIVE STEVENS noted the presence of personnel from
[Archives & Record Management Services] at the hearing.
CHAIR DYSON indicated that testimony was not necessary because
EO 103 was a "slam dunk."
Number 1128
CHAIR DYSON announced that there was no objection, so EO 103
advanced out of House Health, Education and Social Services
Standing Committee.
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 4:23 p.m. [For minutes on the overview
presentations by the Substance Abuse Directors Association of
Alaska and the Association of Rural and Alaska Native Drug &
Alcohol Programs, see the 4:25 p.m. minutes for this date.]
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