Legislature(2023 - 2024)DAVIS 106
04/18/2023 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB127 | |
| HB115 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 127 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 115 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 18, 2023
3:04 p.m.
MEMBERS PRESENT
Representative Mike Prax, Chair
Representative Justin Ruffridge, Vice Chair
Representative CJ McCormick
Representative Dan Saddler
Representative Jesse Sumner
Representative Zack Fields
Representative Genevieve Mina
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 127
"An Act relating to home- and community-based services under the
medical assistance program; and providing for an effective
date."
- HEARD & HELD
HOUSE BILL NO. 115
"An Act relating to the practice of naturopathy; establishing
the Naturopathy Advisory Board; relating to the licensure of
naturopaths; relating to disciplinary sanctions for naturopaths;
relating to the Department of Commerce, Community, and Economic
Development; and providing for an effective date."
- MOVED HB 115 OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 127
SHORT TITLE: HOME AND COMMUNITY-BASED WAIVER SERVICES
SPONSOR(s): REPRESENTATIVE(s) MINA
03/22/23 (H) READ THE FIRST TIME - REFERRALS
03/22/23 (H) HSS, L&C
04/18/23 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 115
SHORT TITLE: NATUROPATHS: LICENSING; PRACTICE
SPONSOR(s): REPRESENTATIVE(s) PRAX
03/17/23 (H) READ THE FIRST TIME - REFERRALS
03/17/23 (H) HSS, JUD, L&C
03/25/23 (H) HSS AT 3:00 PM DAVIS 106
03/25/23 (H) Heard & Held
03/25/23 (H) MINUTE(HSS)
04/06/23 (H) HSS AT 3:00 PM DAVIS 106
04/06/23 (H) Heard & Held
04/06/23 (H) MINUTE(HSS)
04/11/23 (H) HSS AT 3:00 PM DAVIS 106
04/11/23 (H) Heard & Held
04/11/23 (H) MINUTE(HSS)
04/13/23 (H) HSS AT 3:00 PM DAVIS 106
04/13/23 (H) <Bill Hearing Canceled>
04/18/23 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
KATY GIORGIO, Staff
Representative Genevieve Mina
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Read the sectional analysis on behalf of
Representative Mina, prime sponsor.
SARAH KRUG, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 127.
CRYSTAL HOWARD, representing self
Wasilla, Alaska
POSITION STATEMENT: Testified in support of HB 127.
VERONICA PAGE, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 127.
LYNNE KEILMAN-CRUZ, Acting Deputy Director
Division of Senior and Disabilities Services
Department of Health
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
127.
ACTION NARRATIVE
3:04:51 PM
CHAIR MIKE PRAX called the House Health and Social Services
Standing Committee meeting to order at 3:04 p.m.
Representatives Ruffridge, McCormick, Sumner, Fields, Mina, and
Prax were present at the call to order. Representative Saddler
arrived as the meeting was in progress.
HB 127-HOME AND COMMUNITY-BASED WAIVER SERVICES
3:05:50 PM
CHAIR PRAX announced that the first order of business would be
HOUSE BILL NO. 127, "An Act relating to home- and community-
based services under the medical assistance program; and
providing for an effective date."
3:06:59 PM
REPRESENTATIVE MINA, as prime sponsor, paraphrased the sponsor
statement [included in the committee packet], which read as
follows [original punctuation provided]:
Family caregivers provide physical labor to loved ones
while bearing higher rates of emotional stress and
financial strain due to the unpaid nature of their
work. Personal care services are commonly paid through
the Medicaid 1915(k) waiver, also known as the
Community First Choice (CFC) program, allowing
eligible recipients to receive care in their own homes
and communities rather than in institutional settings
such as nursing homes.
In Alaska, legally responsible individuals (e.g.,
spouses, parents, and adult children) are prohibited
from receiving Medicaid compensation for providing
personal care services. The Centers for Medicare and
Medicaid Services (CMS) adopted temporary
flexibilities during the COVID-19 pandemic to allow
payment for personal care services by family members.
However, these flexibilities are tied to the Federal
Public Health Emergency which is set to expire on May
11, 2023.
HB 127 maintains pandemic-related caregiving
flexibilities in Alaska by allowing legally
responsible adults to receive payment for providing
personal care services to Alaskans eligible for the
CFC program.
Home care workers are predicted to be the fourth-most
demanded profession in Alaska, but the state faces a
direct care workforce shortage, especially in rural
areas where home care can be a family's only option.
Family members are often forced to make the personal
sacrifice to fill the gap through unpaid caregiving,
reducing their work hours or even quitting their jobs
altogether and keeping thousands of Alaskans from
realizing their full economic potential. HB 127
addresses the states' over-reliance on unpaid
caregiving by increasing Alaska's caregiving capacity,
promoting economic self-sufficiency for family
caregivers, and supporting the independence and
dignity of aging Alaskans in their home.
3:12:03 PM
KATY GIORGIO, Representative Genevieve Mina, Alaska State
Legislature, on behalf of Representative Mina, prime sponsor,
read the sectional analysis for HB 127, which read as follows
[original punctuation provided]:
Section 1. Amends AS. 47.07.045 and adds a new
subsection:
This allows the state to allow a legally responsible
individual to be paid to provide personal care for a
person who receives Medicaid under the 1915(k) state
plan option.
Section 2. Amends uncodified law by adding a new
section:
This allows the state to amend and submit Section 1
for federal approval of the revised state plan.
Section 3. Amends uncodified law by adding a new
section:
This legislation will only take effect if the U.S.
Department of Health and Human Services approves the
amendment submitted under Section 2. If the federal
government approves the amendment, the commissioner of
health shall notify the revisor of statutes not less
than 30 days after receiving notice of the approval.
Section 4. Provides for an effective date conditional
on approval by federal government.
Legislation would take effect on the 31st day after
the commissioner of health receives notice of approval
of the amendment in Section 1 from the U.S. Department
of Health and Human Services.
Section 5. Provides for an immediate effective date.
Except for the provisions of Section 4, this act would
have an immediate effective date.
3:13:56 PM
SARAH KRUG, representing self, summarized her written testimony
[included in the committee packet], which read as follows
[original punctuation provided]:
Hi, I'm Sarah Krug and I live in Anchorage, Alaska. I
am writing in support of SB 106. I am a care provider,
it is my job and my life. I work as a Paraprofessional
Educator, in a self-contained SPED classroom. I also
work as a Direct Care Provider, under Appendix K, for
my son who has an IDD waiver.
As a care provider I provide and document hands-on
assistance while also supporting a sense of
independence with very personal needs. I assist with
tasks such as showering, toileting, teeth brushing,
medication, tube feeding, range of motion exercises,
position changes, specialized medical equipment and so
much more. These supports help people with the basic
and essential needs in their daily lives. Care
provider jobs require a lot of hard work: physically,
mentally and emotionally. These are low paid jobs,
with high turnover rates. But, paid care providers are
essential to the infrastructure of our society.
I have 3 children that I am raising on my own. Today I
want to tell you about Zachary. Zachary is 17 years
old and has Cerebral Palsy. He uses a power wheelchair
to move and an ipad to communicate. He requires
assistance with almost all his daily needs just to
survive. My son requires an institutional level of
care. But, with the help of care providers, he has the
support he needs to thrive.
Before having a child with a disability I attended UAA
for Social Work, but Zachary needed a lot of
specialized direct care, more than childcare centers
could provide. Lack of qualified care providers
prevented me from obtaining a college degree and
career and continue to limit my ability to work and
support my family.
Zachary was on the waitlist for waiver services for 7
years. After getting a waiver we still struggled to
find, train and retain care providers. Over the last
10 years, we have had some amazing care providers, and
others who just didn't mesh with our family. Working
in someone's home or having someone work in your home
is a unique and intimate experience. Eventually every
care provider we've ever had moved on, which created
an environment of uncertainty, and a sense of
abandonment for a child who didn't understand why. The
revolving door of care providers was very stressful
for my family, especially Zachary.
Covid created chaos and devastation, but it also
challenged us to reevaluate how things have always
been done. Finding different, yet successful, ways of
doing things. There is a significant shortage of care
providers available. This leaves people without
essential care. And families are faced with an
excessive burden that comes with caring for a person
with a disability. There is no easy or one size fits
all solution, but Appendix K allowed family members
the option to be paid for time they work providing
care directly for disabled family members. Allowing
family members to be paid care providers reduces
overall costs of care and keeps people out of
expensive institutions and in their homes and
communities. We need consistent and quality care
providers, and often that is a family member. The
stability and quality care that I am able to provide
for Zachary has been incredible for his development
and goals.
I work and live as a care provider. I am a single mom,
I work two full-time jobs and I still struggle to
support my family. Being able to be paid for some of
the hours that I provide care for my son with Cerebral
Palsy has made my family more self-sufficient, reduced
our need for financial assistance, and overall been a
very positive experience. Disabilities are the only
minority group that any of us can become part of at
any time. Anyone who might experience: an accident,
illness, genetic difference or the effects of aging.
These are our children, parents, family, friends,
neighbors, coworkers. They are a part of our
community. These people matter. We all have a personal
stake in the disability community.
Thank you for taking the steps to make Alaska's care
system work better for everyone. These policy changes
will make a big difference in our community and in the
lives of Alaskan's with disabilities. Please support
policies that continue to allow people to be paid care
providers for family members with disabilities. If you
want to know more or have questions, I am happy to
continue this conversation. You can reach me via phone
call, text or mail.
3:17:37 PM
REPRESENTATIVE SADDLER asked for her perspective on whether a
family member or a professional would be a more effective
professional care assistant.
MS. KRUG responded that it would be an incredible option for
families. She stated that while professional care assistants
may help and provide respite, there is much turnover. She
explained that Zachary would have been further along if he had
consistent care.
3:20:26 PM
CRYSTAL HOWARD, representing self, shared that she has been a
nursing assistant for 24 years. She explained that her family
moved to Alaska in 2012, and in that year, her six-year-old son
was diagnosed with severe aplastic anemia, which made him
transfusion dependent for a year. She said she could not
maintain employment because of his care, as the support system
was inadequate. She recalled that, since he was so ill, they
could not go to Oregon where a larger support system would be.
She said HB 127 is important for struggling caregivers in the
state. She expressed the opinion that the need for family
caregivers is only going to increase.
3:23:47 PM
VERONICA PAGE, representing self, paraphrased her written
testimony [included in the committee packet], which read as
follows [original punctuation provided]:
My name is Veronica Page and I live in Anchorage. I am
writing in support of SB 106 and HB 127. This bill
will allow family members to be paid to provide care
for their loved ones permanently. I'm asking you to
support this bill as well.
My wedding dress is hanging in my garage unworn. One
month before our wedding my fiance was in a
devastating accident. He was expected to be in a
permanent vegetative state- never to eat, to walk, to
live the way we'd always planned. I never got to say
my vows, but I have stuck by my partner every step of
the way over the last 12 years as his sole care
provider. By the healing grace of God he has made an
incredible recovery. He can do most of the things
doctors were sure he wouldn't ever be able to.
We never married because in the state of Alaska being
married would have meant that I would not be able to
be paid as a caregiver for my husband. The care was
24/7 around the clock- there was no way for me to work
another job and frankly, he didn't want other people
seeing him in that position. There aren't enough
caregivers in Alaska and there are many people who
don't have the training they need to be effective at
work. Anything less than excellent care would have
hindered his recovery. We couldn't take that chance,
and we had to pay for housing somehow.
We are a Christian family and every day of the last 12
years I have been living in sin against my values and
denied my dream. We could never take the chance, even
in the last few years, that our marriage could cost us
my sole income- cost us everything, and so we have
done what we had to do to be well and keep the bills
paid. Alaskans deserve choice. Many families, like
mine, want to take care of each other and they're the
best caregivers delivering care at the highest level.
We deserve to make a living doing the same work that
other caregivers do. We deserve to be married, and we
deserve to be paid.
3:31:18 PM
REPRESENTATIVE RUFFRIDGE referred to page 1, section 1, line 7
of the proposed legislation and questioned the reasoning for
picking just one waiver option, the state's 1915(k) plan.
REPRESENTATIVE MINA explained that personal care assistants are
under the 1915(k) waiver, since the bill specifically relates to
such assistants for those receiving care at their own home.
REPRESENTATIVE RUFFRIDGE offered his understanding that there
are other waiver options that allow for personal care.
3:33:47 PM
LYNNE KEILMAN-CRUZ, Acting Deputy Director, Division of Senior
and Disabilities Services, Department of Health, explained that
the Community First Choice is a state plan option, and it is
referred to as the 1915(k) program. She stated that there is
also a state plan for personal care under 1905(a); however,
Medicare and Medicaid in this plan do not allow legally
responsible individuals to provide personal care. She advised
that the federal government would allow the state to proceed
with the Community First Choice program, as proposed in the
bill. She noted that home and community-based waivers are under
a different authority in the federal government and are not
being currently considered.
REPRESENTATIVE RUFFRIDGE inquired as to whether someone who only
qualifies for the 1905(a) could receive personal care services
offered by legally responsible persons.
MS. KEILMAN-CRUZ responded that individuals who receive personal
care under 1905(a) would not be eligible to receive services
from a legally responsible individual.
REPRESENTATIVE RUFFRIDGE asked how many are currently receiving
personal care services under 1915(k) compared to 1905(a).
MS. KEILMAN-CRUZ offered her understanding that there are 700
people receiving care under the 1915(k) program.
3:37:24 PM
REPRESENTATIVE SADDLER asked if the intended effect of the
proposed bill is to allow family members who provided care
during the Covid-19 pandemic to continue, or to expand such
services to family members.
REPRESENTATIVE MINA answered yes to both.
REPRESENTATIVE SADDLER asked if there is any level of training
or qualifications required for a family member to provide
personal care services.
REPRESENTATIVE MINA answered that personal care assistants would
still have to have the qualifications and training.
3:38:48 PM
MS. KEILMAN-CRUZ explained that requirements for personal care
assistants are the same for all employees of the agency, and
this would include passing a criminal history check, receiving
first aid and CPR training, and training in the specific care
for the person.
3:39:46 PM
REPRESENTATIVE SADDLER observed that the fiscal note states that
there would be no additional expenses with HB 127, as it relates
to the Department of Health. He continued that it does not
address what the increase would be in the state's Medicaid
costs. He asked for an estimate of what the increase in costs
would be.
REPRESENTATIVE MINA offered her understanding that there is a
dwindling caregiver population in Alaska. She said allowing
family members and legally responsible individuals to become
caregivers may help balance the workforce gap. She asked the
department to address the fiscal note.
3:40:50 PM
MS. KEILMAN-CRUZ concurred with the explanation given. She
explained that there would be no change to the level of services
that are authorized by the division; rather, it would only add
the potential for employees who are legally responsible
individuals to provide the service. She explained that if a
service were authorized but not utilized due to not finding a
caregiver, the person would be allowed to provide the authorized
care.
REPRESENTATIVE SADDLER questioned the increase in the amount of
Medicaid expenses. He questioned whether there would be a net
change in providers.
MS. KEILMAN-CRUZ explained that the services are already
authorized; therefore, there is no expectation of an increase in
the number of caregivers to meet the shortage.
REPRESENTATIVE SADDLER expressed the opinion that HB 127 is a
"good" bill. If people learn that they can be paid for taking
care of a family member, he questioned whether there would be an
expansion of agencies with provider services.
MS. KEILMAN-CRUZ said that a recent survey was conducted with
providers to determine how many were using legally responsible
individuals, with little response. She explained that there has
been a decrease in the workforce overall.
3:44:15 PM
CHAIR PRAX inquired about the training certification process
that is required and what the timeline is.
MS. KEILMAN-CRUZ explained that training requirements depend on
whether the person is receiving consumer direct care or personal
care.
3:46:27 PM
REPRESENTATIVE SADDLER asked if a personal care assistant is
also a legally responsible individual and an action taken by
them harms the person in care, who would be legally responsible.
MS. KEILMAN-CRUZ explained that in the personal care programs,
the individuals providing care would be enrolled in Medicaid and
connected to the agency. She stated that this would allow the
agency to hold the individual providing care accountable, as
well as the agency itself.
REPRESENTATIVE SADDLER asked why the personal care assistants
would be under the Medicaid program.
MS. KEILMAN-CRUZ answered that it would be one way to take
action against the person providing care, and it would help in
mitigating fraud, waste, and abuse.
3:50:21 PM
CHAIR PRAX asked whether regulations that go along with the
proposed legislation are already established.
MS. KEILMAN-CRUZ responded that the state agency would need to
develop regulations to create the framework for the service.
She stated the department is in favor of the bill because it
would start with a small program, which is allowable under
federal rule. She added that starting with a smaller program
would allow the time to put a framework in place before the
program would be offered on a larger scale.
3:51:50 PM
CHAIR PRAX asked if there were anything that would need to be
done with the proposed legislation to make it easier for
providers to enroll.
MS. KEILMAN-CRUZ expressed uncertainty.
3:53:06 PM
CHAIR PRAX announced that HB 127 was held over.
3:53:50 PM
The committee took an at-ease from 3:53 p.m. to 4:00 p.m.
HB 115-NATUROPATHS: LICENSING; PRACTICE
4:00:44 PM
CHAIR PRAX announced that the final order of business would be
HOUSE BILL NO. 115, "An Act relating to the practice of
naturopathy; establishing the Naturopathy Advisory Board;
relating to the licensure of naturopaths; relating to
disciplinary sanctions for naturopaths; relating to the
Department of Commerce, Community, and Economic Development; and
providing for an effective date."
4:01:03 PM
REPRESENTATIVE RUFFRIDGE moved to report HB 115 out of committee
with individual recommendations and the accompanying fiscal
notes.
4:01:18 PM
REPRESENTATIVE SUMNER objected. He pointed out that the
committee did substantive work on the bill. He asked why the
original bill was being advanced [and not the proposed committee
substitute].
REPRESENTATIVE RUFFRIDGE answered that the original bill has
more components to work on, and amendments proposed in the
committee substitute would also need more work.
4:02:23 PM
REPRESENTATIVE SUMNER removed his objection.
4:02:33 PM
CHAIR PRAX, after ascertaining that there was no further
objection, announced that HB 115 was reported out of the House
Health and Social Services Standing Committee.
4:02:48 PM
The committee took an at-ease from 4:02 p.m. to 4:03 p.m.
4:03:24 PM
CHAIR PRAX advised that the original version of HB 115 was
passed out of the House Health and Social Services Standing
Committee.
4:03:52 PM
The committee took an at-ease from 4:03 p.m. to 4:08 p.m.
4:08:04 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:08 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 127 Fiscal Note DoH.pdf |
HHSS 4/18/2023 3:00:00 PM |
HB 127 |
| HB 127 Letters of Support 4.12.23.pdf |
HHSS 4/18/2023 3:00:00 PM |
HB 127 |
| HB 127 Sectional Analysis Version A 4.12.23.pdf |
HHSS 4/18/2023 3:00:00 PM |
HB 127 |
| HB 127 Sponsor Statement Ver. A 4.12.23.pdf |
HHSS 4/18/2023 3:00:00 PM |
HB 127 |
| HB0127A.PDF |
HHSS 4/18/2023 3:00:00 PM |
HB 127 |