04/13/2021 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB168 | |
| HB103 | |
| SB21 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 168 | TELECONFERENCED | |
| + | HB 103 | TELECONFERENCED | |
| + | SB 21 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 13, 2021
3:08 p.m.
MEMBERS PRESENT
Representative Liz Snyder, Co-Chair
Representative Tiffany Zulkosky, Co-Chair
Representative Ivy Spohnholz
Representative Zack Fields
Representative Ken McCarty
Representative Mike Prax
Representative Christopher Kurka
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 168
"An Act requiring the Department of Health and Social Services
to provide and allow submission of an electronic application for
certain state benefits; and providing for an effective date."
- HEARD & HELD
HOUSE BILL NO. 103
"An Act relating to house rules for assisted living homes."
- HEARD & HELD
SENATE BILL NO. 21
"An Act relating to mobile intensive care paramedics; relating
to duties of the State Medical Board and the Department of
Health and Social Services; and providing for an effective
date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 168
SHORT TITLE: ELECTRONIC APPLICATION FOR STATE BENEFITS
SPONSOR(s): REPRESENTATIVE(s) SNYDER
04/09/21 (H) READ THE FIRST TIME - REFERRALS
04/09/21 (H) HSS, FIN
04/13/21 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 103
SHORT TITLE: ASSISTED LIVING HOMES: HOUSE RULES
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
02/18/21 (H) READ THE FIRST TIME - REFERRALS
02/18/21 (H) STA, HSS
03/18/21 (H) STA AT 3:00 PM GRUENBERG 120
03/18/21 (H) Heard & Held
03/18/21 (H) MINUTE(STA)
03/25/21 (H) STA AT 3:00 PM GRUENBERG 120
03/25/21 (H) -- MEETING CANCELED --
04/01/21 (H) STA AT 3:00 PM GRUENBERG 120
04/01/21 (H) Moved HB 103 Out of Committee
04/01/21 (H) MINUTE(STA)
04/05/21 (H) STA RPT 6DP
04/05/21 (H) DP: CLAMAN, STORY, KAUFMAN, VANCE,
TARR, KREISS-TOMKINS
04/08/21 (H) STA AT 3:00 PM GRUENBERG 120
04/08/21 (H) <Bill Hearing Canceled>
04/13/21 (H) HSS AT 3:00 PM DAVIS 106
BILL: SB 21
SHORT TITLE: LICENSE MOBILE INTENSIVE CARE PARAMEDICS
SPONSOR(s): REVAK
01/22/21 (S) PREFILE RELEASED 1/8/21
01/22/21 (S) READ THE FIRST TIME - REFERRALS
01/22/21 (S) HSS, L&C
03/02/21 (S) HSS AT 1:30 PM BUTROVICH 205
03/02/21 (S) Heard & Held
03/02/21 (S) MINUTE(HSS)
03/04/21 (S) HSS AT 1:30 PM BUTROVICH 205
03/04/21 (S) Moved SB 21 Out of Committee
03/04/21 (S) MINUTE(HSS)
03/05/21 (S) HSS RPT 3DP 1NR
03/05/21 (S) DP: WILSON, COSTELLO, HUGHES
03/05/21 (S) NR: BEGICH
03/15/21 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
03/15/21 (S) Moved SB 21 Out of Committee
03/15/21 (S) MINUTE(L&C)
03/17/21 (S) L&C RPT 4DP
03/17/21 (S) DP: STEVENS, GRAY-JACKSON, REVAK,
HOLLAND
03/22/21 (S) TRANSMITTED TO (H)
03/22/21 (S) VERSION: SB 21
03/24/21 (H) READ THE FIRST TIME - REFERRALS
03/24/21 (H) HSS, L&C
04/13/21 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
ARIELLE WIGGIN, Staff
Representative Liz Snyder
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided a sectional analysis for HB 168 on
behalf of Representative Snyder, prime sponsor.
ROBBI MIXON, Executive Director
Alaska Farmers Market Association
Executive Director
Alaska Food Policy Council
Homer, Alaska
POSITION STATEMENT: Provided invited testimony in support of HB
168.
CARA DURR, Director of Public Engagement
Food Bank of Alaska
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony in support of HB
168.
SHAWNDA O'BRIEN, Director
Division of Public Assistance
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: During the hearing of HB 168, answered
questions related to the bill.
JOHN LEE, Director
Division of Senior and Disability Services
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Presented HB 103 on behalf the House Rules
Standing Committee, sponsor, by request of the governor.
CRAIG BAXTER, Program Manager
Residential Licensing Section
Division of Health Care Services
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: During the hearing of HB 103, answered
questions on behalf of the House Rules Standing Committee by
request of the governor.
LYNNE KEILMAN-CRUZ, Chief of Quality
Division of Senior and Disabilities Services
Department of Health and Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: During the hearing of HB 103, answered
questions on behalf of the House Rules Standing Committee,
sponsor, by request of the governor.
MICHAEL GARVEY, Advocacy Director
American Civil Liberties Union of Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 103.
SENATOR JOSH REVAK
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As the prime sponsor, presented SB 21.
SETH DUGGAN, Staff
Representative Josh Revak
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Provided the sectional analysis for SB 21
on behalf of Senator Revak, prime sponsor.
BRIAN WEBB, Emergency Medical Services Officer
Division of Public Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
21.
SARA CHAMBERS, Director
Division of Corporation, Business, and Professional Licensing
Department of Commerce, Community, and Economic Development
Juneau, Alaska
POSITION STATEMENT: During the hearing of SB 21, answered
questions.
WILMA VINTON
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of SB 21.
ACTION NARRATIVE
3:08:27 PM
CO-CHAIR LIZ SNYDER called the House Health and Social Services
Standing Committee meeting to order at 3:08 p.m.
Representatives Spohnholz, McCarty, Prax, Kurka, Zulkosky, and
Snyder were present at the call to order. Representative Fields
arrived as the meeting was in progress.
HB 168-ELECTRONIC APPLICATION FOR STATE BENEFITS
3:09:56 PM
CO-CHAIR SNYDER announced that the first order of business would
be HOUSE BILL NO. 168, "An Act requiring the Department of
Health and Social Services to provide and allow submission of an
electronic application for certain state benefits; and providing
for an effective date."
3:10:20 PM
CO-CHAIR SNYDER took a brief at-ease to pass the gavel to Co-
Chair Zulkosky.
3:11:16 PM
CO-CHAIR SNYDER, as prime sponsor, presented HB 168. She
explained the bill would require the addition of an online
submission option for public assistance applications through the
state's internet site, but nothing in the bill would change
current options for applying for public assistance. Current
options include mailing, faxing, dropping off in person, and in
some instances downloading, completing, and sending the
application as an email attachment. She noted that during a
budget subcommittee meeting, the Division of Public Assistance
(DPA), Department of Health and Social Services (DHSS), stated
that it is working to get the online submission option up and
running. Thus, HB 168 would put the division's work into
statute, thereby protecting it into the future.
CO-CHAIR SNYDER related that HB 168 would apply to a variety of
public assistance programs, including Medicaid for chronic and
acute medical assistance; supplemental nutrition assistance
through the Supplemental Nutrition Assistance Program (SNAP);
adult public assistance; senior benefits program; heating
assistance; Women, Infants, and Children (WIC) Program; and the
Commodity Supplemental Food Program that is for seniors over 60
who need access to supplemental food; along with renewals and
recertifications.
3:13:58 PM
CO-CHAIR SNYDER discussed the three primary points of motivation
for adding an online application submission as an option for
these programs. She said the first motivation is that it
modernizes the process to reflect typical current practices.
For example, the United State Department of Agriculture (USDA),
which administers SNAP, has been providing guidance to states on
best practices for online SNAP applications since at least 2006.
Alaska is one of a small number of states that does not yet have
the online application option. Even before the COVID-19
pandemic, adding online submission options has been the trend
because it addresses the other two motivations of HB 168.
CO-CHAIR SNYDER related that the second motivation is to remove
barriers to access. She explained that the purpose of public
assistance programs is to help Alaskans get through a
challenging time in their lives, and the fewer barriers put in
front of that path the faster folks can achieve positive
outcomes. While some barriers may not seem large, they can be a
big deal. For example, having a printer is necessary when a
signature on the application is required and cannot be done
online. In Alaska's rural areas there may be issues with the
frequency and consistency of postal service, adding excess time
to the submission of an application.
CO-CHAIR SNYDER conveyed that the third motivation is improved
efficiency for the division through online applications. She
said paper processing is slow and takes up much staff time,
contributing to backlogs and long review times. The governor's
budget, in anticipation of efficiencies that will be provided by
online applications, included cuts of nearly $1 million in
reduced needs for postage and supplies and the elimination of
dozens of positions that would be unnecessary with online
applications. She said a fiscal note has not yet been received
but will be shared as soon as it is available.
CO-CHAIR SNYDER summarized that HB 168 would put the division's
current modernization work into statute and the addition of an
online submission option for public assistance would remove
barriers to access and improve processing efficiencies, saving
money and time for the state.
3:18:07 PM
ARIELLE WIGGIN, Staff, Representative Liz Snyder, Alaska State
Legislature, provided a sectional analysis for HB 168 on behalf
of Representative Snyder, prime sponsor. She paraphrased from
the written sectional analysis titled, "SECTIONAL ANALYSIS, HB
168: ELECTRONIC APPLICATION FOR STATE BENEFITS, Ver. W," which
read [original punctuation with some formatting changes]:
Sec. 1: Adds a new subsection (19) to AS 47.05.010
Duties of Department requiring the Department of
Health and Social Services to create and provide an
entirely online application process for individuals
applying for public assistance and defines an online
application. It does not mandate applicants apply
online or remove the written option.
Sec. 2: Amends AS 47.08.150(b) Assistance For Chronic
or Acute Medical Conditions by adding language
requiring the Department of Health and Social Services
to establish an entirely online application process
for individuals applying for the Chronic and Acute
Medical Assistance program.
Sec. 3: Adds a new subsection (6) to AS 47.25.001(a)
Powers and Duties that requires the department
establish an entirely online application process and
allows applicants to apply in any form required by
state and federal law.
Sec. 4: Adds a new section (7) to AS 47.25.071(e)
Child Care Grant Program that requires the department
establish an entirely online application process for
assistance under the Child Care Grant Program.
Sec. 5: Amends AS 47.25.095 Definitions For Day Care
Assistance and Child Care Grant Programs to define
electronic application.
Sec. 6: Amends AS 47.25.150 Application For Assistance
by adding language requiring the Department of Public
Assistance to establish an entirely online application
process for individuals applying for assistance from
the department and defines an online application.
Sec. 7: Amends AS 47.25.440 Application For Assistance
by adding language requiring the Department of Health
and Social Services to establish an entirely online
application process for individuals applying to
receive Adult Public Assistance and defines an online
application.
Sec. 8: Adds a new subsection (4) to AS 47.25.622
Alaska Affordable Heating Program requiring the
Department of Health and Social Services to create and
provide an entirely online application process for
individuals applying for the Alaska Affordable Heating
Program and defines an online application.
Sec. 9: Adds a new subsection (4) to AS 47.25.980(a)
Duties of Department requiring the Department of
Public Assistance to create and provide an entirely
online application process for individuals applying
for the Supplemental Nutrition Assistance Program and
defines an online application.
Sec. 10: Amends AS 47.27.020(a) Application
Requirements by adding language requiring the
Department of Public Assistance to establish an
entirely online application process for individuals
applying for the Alaska Temporary Assistance Program.
Defines online application.
Sec. 11: Amends AS 47.45.302(a) Cash Assistance
Benefits by adding language requiring the Department
of Health and Social Services to establish an entirely
online application process for individuals applying
for the cash assistance program. Defines online
application.
Sec. 12: Adds a new section to the uncodified law of
the State of Alaska allowing the Department of Health
and Social Services to adopt regulations needed to
create and implement online applications.
Sec. 13: Requires Section 12 to take effect
immediately under AS 01.10.070(c).
Sec. 14: Provides an effective date of July 1, 2022.
3:19:26 PM
CO-CHAIR ZULKOSKY opened invited testimony.
3:19:48 PM
ROBBI MIXON, Executive Director, Alaska Farmers Market
Association, Executive Director, Alaska Food Policy Council,
provided invited testimony in support of HB 168. She stated
that electronic public assistance applications would create
greater government efficiencies and expand the number of people
able to access these benefits. These benefits are a vehicle for
accessing healthy food and allow for making healthier food
choices. It also provides funds for local produce and quality
proteins that are often outside of some people's budgets,
providing more equity in accessing healthy foods.
MS. MIXON noted that programs like SNAP increase recipients'
purchasing power and allows them to access local foods or
programs like farmers market SNAP and doubling programs.
Bolstering opportunities like this for local farmers is in
direct alignment with Governor Dunleavy's declared interest in
expanding Alaska's agricultural industry. Increasing access to
public food assistance benefits would also support Alaska's
growing food sectors, increasing sales for Alaska's farmers and
food producers. Every dollar spent in SNAP generates about
$1.80 in economic activity for local economies.
MS. MIXON added that allowing for electronic applications would
go a long way in creating greater food security in Alaska, which
is important given one in six Alaskan children go to bed each
night food insecure. The bill holds many potential benefits
with very low costs, she stated in conclusion.
3:22:34 PM
CARA DURR, Director of Public Engagement, Food Bank of Alaska,
provided invited testimony in support of HB 168. She related
that the Food Bank hopes the bill will ensure that the division
has the support and resources needed to achieve its goal of
providing an online application. She said she oversees the Food
Bank's SNAP Outreach Program, a federally funded program done in
partnership with the state. Broadly, her program's charge is to
provide education, outreach, application assistance, and case
status updates for current and potential SNAP clients.
MS. DURR noted that Alaska has a lower participation index for
SNAP, about 76 percent, which speaks to the number of people who
are eligible and able to access the program. According to the
USDA, she continued, about 25 percent of the people in Alaska
who are eligible are not accessing the program. Some of the
reasons for this can be addressed and some cannot. One barrier
is access and the lack of options on how to apply, and an online
application would improve this. The current paper application
requires a "wet" or "pen-to-paper" signature. The division is
working on some alternative signature options, like an e-
signature or a telephonic signature. The Food Bank has recently
received a waiver from USDA specific to COVID-19 flexibilities,
which allows the Food Bank to be an authorized representative
and sign on behalf of clients who aren't able to see the Food
Bank in person. Since it is tied to COVID-19 it is unknown how
long this will last, but these are important flexibilities to
continue because the more options the better.
MS. DURR stated that given COVID-19, many DPA offices are
closed, plus many communities don't have DPA offices; therefore,
people don't have a way to get applications. Some clients don't
have access to the online PDF document, some don't have printing
or mailing capabilities, and some need help with understanding
the questions that are asked on the 28-page application. The
Food Bank is helping people over the phone by asking questions
of the client and filling out the application on the Food Bank's
end. If a client doesn't have printing capabilities, the Food
Bank then mails the application to the client with a pre-paid
return envelope, the client then reviews, signs, and mails back
the application. This process can take weeks for clients in
rural communities and many times the application doesn't get
submitted for one reason or another. She said she knows that if
clients had access to the internet and could self-submit, even
with guidance from the Food Bank over the phone, it would be a
great option for them and would save the mailing time and
associated costs.
MS. DURR said another benefit of an online application is that
it can simplify the application per client. Currently clients
can apply for multiple benefits at the same time, but that
results in a long application and some of the questions are not
always relevant. When helping clients, the Food Bank Outreach
Team knows which questions are required and which aren't, which
simplifies the daunting process for clients. She suggested
making the online application predictive so it could allow
clients to just answer the questions that are relevant to the
programs they are applying for and could even provide further
explanation of the information needed. She concluded by
expressing the Food Bank's support for the bill.
3:27:57 PM
REPRESENTATIVE KURKA drew attention to Section 5 of the bill and
noted that the State of Alaska already has infrastructure for
electronic signatures in the myAlaska system, a seemingly
natural infrastructure from which to build this. He interpreted
the bill's language as directing the department to have the
application submitted through the department's website. He
asked whether the bill would be building a competitive
infrastructure.
CO-CHAIR SNYDER replied that the interest is in whatever is
necessary to create an efficiency. She said the language in the
bill came from talking with the department and Legislative Legal
Services. She deferred to the department to further answer the
question.
3:30:08 PM
SHAWNDA O'BRIEN, Director, Division of Public Assistance (DPA),
Department of Health and Social Services (DHSS), responded that
DPA has been exploring options to use myAlaska as the platform
for validation and verification of an individual's identity
given that that platform would be the most efficient and
advantageous way to move forward. However, she explained, the
division has been unable to get the USDA to allow using the
myAlaska single sign-on for the application because it requires
the individual to have an email address as a means for
contacting them, and that goes against USDA's regulatory
oversight. Therefore, DPA will most likely have to pursue
another platform for folks to apply for SNAP benefits. The
division is continuing to see if there is something else that
would still enable taking advantage of myAlaska because that
would make more sense. She added that DPA has used the argument
that Alaska is unique in that most individuals applying for a
permanent fund dividend (PFD) have a myAlaska account, which
means that people are familiar with that already.
REPRESENTATIVE KURKA asked whether the bill's current language
would preclude DPA from using myAlaska if the division is able
to make it work through the department's website.
MS. O'BRIEN answered that she does not believe the language in
the bill would prohibit DPA from doing whatever means it needed
to make that happen. She said she reads the bill as giving DPA
the flexibility to use any internet type platform as long as the
recipients are not in any way excluded from participating.
REPRESENTATIVE KURKA inquired about the percentage of Alaskans
who use myAlaska versus other options to apply for the PFD.
MS. O'BRIEN offered her understanding that more Alaskans use it
to apply for their PFD than not, but she doesn't know the
number.
3:33:29 PM
REPRESENTATIVE SPOHNHOLZ asked whether DPA's work to create an
online application process is being done in-house or through
contracting.
MS. O'BRIEN replied that DPA has been communicating with the
vendor that did the PFD application, as well as the document
management system, for the Department of Revenue. She stated
that this vendor also developed and implemented DPA's document
management system, and that DPA has been working with the vendor
to ensure that the division's document management system and its
workflow management system are aligned to receive all those
documents electronically. Right now, she continued, DPA is
entering into the initial procurement stages of that project and
hopes to have the procurements approved and work underway in the
next couple months. The work the vendor has done with the PFD
includes the ability of the application to be predictive so that
it streamlines and limits the types of questions an individual
is made to respond to when applying, for example, for just SNAP.
This is advantageous to DPA and will be beneficial for both the
user and DPA staff. She pointed out that the USDA funding
currently being made available to states is a good opportunity
for DPA to maximize its federal funding sources to fund this
project. The division is trying to take advantage of that, so
it is using less state general funds from its capital projects
to accomplish this.
REPRESENTATIVE SPOHNHOLZ remarked that it seems the predictive
application could be constructive because some people may not
understand that they don't need to fill out every page of the
application. She noted that people can already apply for
Medicaid at myAlaska.gov. She asked whether there are any
provisions in the American Rescue Plan Act of 2021 (ARPA) that
might be used in addition to the USDA funding.
MS. O'BRIEN answered that there is funding under the ARPA to
cover 100 percent of the administrative costs, so DPA has been
working to identify what documentation is necessary to take
advantage of that funding going forward for as long as that
funding will be available. She added that the division is
getting close to having those answers.
3:37:33 PM
REPRESENTATIVE SPOHNHOLZ offered her understanding that an email
address is needed on the USDA's SNAP application and that the
state could potentially apply for a waiver to the USDA. She
inquired whether there are any other programs that would require
some special permission from the federal government to do this.
MS. O'BRIEN replied that it is the reverse the USDA
requirements would not allow DPA to require that an individual
provide an email address as a part of the authentication and
that is what DPA is has been trying to work through. She stated
that because DPA wants to get this going and get something in
place sooner than later, the division is proceeding as if it
will not be able to take advantage of the myAlaska platform for
SNAP benefits. She said there aren't any restrictions in place
for the other programs that would be prohibitive that way.
REPRESENTATIVE SPOHNHOLZ asked whether DPA is proceeding as if a
waiver won't be received for using myAlaska, or whether DPA is
assuming that it cannot get a waiver and is not going to try.
MS. O'BRIEN responded that in this case there is not an option
for DPA to apply for a waiver. She related that she has put in
writing to USDA the argument that many of the recipients in
Alaska are already using myAlaska for applying for the PFD.
Using that logic she was hoping to persuade USDA to give DPA
permission to use the myAlaska platform and still have options
for folks who don't have an email address to use some other
platform.
3:40:21 PM
REPRESENTATIVE MCCARTY asked whether the USDA is giving DPA any
solutions for not being able to use myAlaska or when people
don't have an email address.
MS. O'BRIEN answered that the USDA requires a mailing address
for communicating with recipients, so DPA would have an option
for folks to elect to communicate with the division; however,
DPA cannot require folks to have an email and that is where the
difference is. She said myAlaska requires individuals to have
an email address as a means for communication or identification,
but DPA cannot use that for the purposes of the application for
SNAP; DPA has to have the mailing address as the primary means
of communication and notification. Responding further to
Representative McCarty, she confirmed that DPA must require a
mailing address but cannot require an email address.
REPRESENTATIVE MCCARTY inquired about checks and balances for
fraud given that multiple people may use the same mailing
address.
MS. O'BRIEN confirmed that multiple individuals may share a
single mailing address. She stated that for purposes of the
program, validation of the residence or the mailing address
being used on record is something DPA's fraud unit would look
into if there were reasons to suspect that an individual was
fraudulently using the system. Regarding the application, she
said many folks may use the same mailing address for various
reasons, but she cannot speak to what the requirements are for
USDA's purposes in terms of validating an individual based on a
mailing address versus an email address. She offered to get
additional information to the committee.
3:43:49 PM
CO-CHAIR SNYDER stated that the addition of an online
application does not affect the possibility of some misuse in
addition to what is already possible with the other forms of
application, and therefore it is a separate question. She said
the level of misuse and abuse is a single digit percentage and
that [DPA] has been working over the years to address that, such
as using electronic benefit transfer cards.
MS. DURR agreed with Co-Chair Snyder's summation. She said SNAP
has very low rates of fraud, waste, and abuse, and she doesn't
see an online application as inviting more fraud. Fraud is
taken seriously, she added, because the program is important and
DPA doesn't want to see people misusing it.
REPRESENTATIVE MCCARTY stated that he likes making things easier
to process but asked what is being done in the electronic system
to recognize red flags.
CO-CHAIR ZULKOSKY responded that this is a related but separate
question that can be discussed when the committee again
considers HB 168. She said the bill focuses on creating an
online application system, not on conflating the two issues.
3:46:56 PM
REPRESENTATIVE PRAX inquired whether this idea could be
accomplished without passing a statute.
CO-CHAIR SNYDER answered that part of the motivation is to
provide statutory support for this work that has begun but has
taken quite a long time to achieve. She said procurement is
required which has an associated cost, and that has been
addressed in the budget. But the number one reason is because
if [the state] is going to invest and get this best practice
operational in this department, having it in statute protects
the online application option from being easily removed by
future administrations. As seen with other states that have
adopted this, it is a good plan, improves efficiency, saves
time, and removes barriers to access these programs, and having
it in statute protects that.
REPRESENTATIVE PRAX asked whether a fiscal note will be
associated with the bill given it is a project with a beginning
and an end and a cost somewhere.
CO-CHAIR SNYDER replied that a fiscal note is being awaited and
will be provided to the committee as soon as it is received.
She concurred that a cost is anticipated but said it is expected
that the cost will be balanced out with some of the proposed
cuts that foresee the savings generated by putting it online.
3:49:13 PM
REPRESENTATIVE PRAX noted that the word "needy" is used several
times throughout the bill. He maintained that this word is
unnecessary and asked whether this language could be cleaned up.
CO-CHAIR SNYDER offered her understanding and suggested that it
is an amendment the committee could consider. She noted that
the bill also references the outdated term "food stamps," which
has been brought to the attention of DHSS as a possible change.
3:50:33 PM
REPRESENTATIVE KURKA conveyed that 15.16 percent of PFD
applications are through paper, 8.07 percent are online paper
signature, and 76.77 percent are the online electronic signature
process. He stated that procuring and having a mailing address
would be more difficult than an email address but qualified that
this is not meant as an argument with DHSS.
CO-CHAIR ZULKOSKY announced that public testimony on HB 168 will
be heard on 4/15/22.
[HB 168 was held over.]
3:51:26 PM
CO-CHAIR ZULKOSKY took a brief at-ease to return the gavel to
Co-Chair Snyder.
HB 103-ASSISTED LIVING HOMES: HOUSE RULES
3:51:52 PM
CO-CHAIR SNYDER announced that the next order of business would
be HOUSE BILL NO. 103, "An Act relating to house rules for
assisted living homes." She noted the bill is from the House
Rules Standing Committee by request of the governor.
3:53:02 PM
JOHN LEE, Director, Division of Senior and Disability Services,
Department of Health and Social Services (DHSS), presented HB
103 on behalf of the House Rules Standing Committee, sponsor, by
request of the governor. He stated that the bill is needed
because Alaska's statutes are not in compliance with federal
regulations which require home and community-based services
(HCBS) providers to give people who are on waivers the same
access to the community as people who are not on waivers. The
term waiver, he explained, refers to the federal programs that
allow people who would otherwise be in an institution at a much
higher cost the opportunity to live in non-institutional
settings such as an assisted living facility.
MR. LEE said [Alaska] state law allows that assisted living
homes may establish house rules that address residents' right to
have visitors. While [Alaska] statute says the rules may not be
unusually restrictive the federal regulations are much more
explicit, stating that individuals on waivers and in such
settings are able to have visitors of their choosing at any
time. Although Alaska received initial approval from the
federal government for its plan to bring its settings into
compliance, this approval was contingent on the state revising
its statutes to reflect this federal statute. Ongoing financial
participation in the state's waiver programs by the federal
government is reliant on services being provided in compliant
settings. Without this amendment to state statutes, the federal
government's match is jeopardized.
MR. LEE explained that HB 103 addresses this need by proposing a
simple insertion of language into the assisted living home
statute that would bring the state into compliance with the
Centers for Medicare and Medicaid Services (CMS) home and
community-based setting requirement, protecting Alaska's federal
share of Medicaid payments for home and community-based waiver
services. The bill would ensure that recipients of residential
waiver services will be able to live under conditions that are
as much like the person's home as possible.
MR. LEE stated that HB 103 would impact Alaska's approximately
700 assisted living homes, which would be required to abide by
the conditions defined in the bill. The new statutory language
would afford all residents living in an assisted living home the
same rights regardless of whether the home accepts Medicaid as
payment or not. Over 650 of the homes are already compliant
with the conditions set forth in this legislation because they
have been certified to operate home and community-based waiver
services under these conditions.
MR. LEE noted that there is a timeline - all states are required
by the federal government to be compliant by March 2023. He
further noted that there is zero fiscal impact for the bill.
3:56:12 PM
MR. LEE provided the sectional analysis for HB 103. He stated
that Section 1 would amend Alaska Statute (AS) 47.33.060, House
Rules for Assisted Living Homes, to explicitly require
consistency with federal regulation when house rules are
established. He explained that Section 2 would add a new
section for assisted living homes to make explicit that assisted
living homes that provide waiver services may not adopt house
rules inconsistent with federal regulations. He said Section 3
carries the statutory amendments proposed in Section 1 and
Section 2 of the bill to AS 47.33.300(a) regarding a resident's
rights to have visitors.
3:57:10 PM
REPRESENTATIVE KURKA asked whether these new requirements would
have to be followed by an assisted living home or private home
that is outside of state or federal government assistance.
MR. LEE replied that of the 700 homes operating in Alaska and
licensed by the state, only about 50 do not currently accept
waiver payments funds. He pointed out that all facilities must
be compliant with federal statutes, and HB 103 would ask those
50 facilities that are not participating in waiver programs to
also be compliant.
REPRESENTATIVE KURKA referred to Section 2 and asked why these
"strings" should apply to homes that do not receive funding.
MR. LEE responded that it is for consistency and to not have
separate requirements depending on who is the payer, and that
all individuals be treated with the same dignity and respect.
He deferred to Mr. Craig Baxter to further answer the question.
3:59:56 PM
CRAIG BAXTER, Program Manager, Residential Licensing Section,
Division of Health Care Services, Department of Health and
Social Services (DHSS), answered the question on behalf of the
House Rules Standing Committee by request of the governor. He
concurred with Mr. Lee's answer. He said many of the residents
are private pay and not participating in the home and community-
based waiver program. In addition, many of the 50 facilities
that are not currently waiver certified will become waiver
certified in the future as many of them are in their provisional
year of licensure and have not completed the certification
process. It is to have facilities consistent, he continued, so
that the expectation is the same for visitation regardless of
where a person lives if he or she is in an assisted living home.
Residents can receive visitors of their choosing when they
choose in whatever facility they live, just like people who live
in their personal residences.
4:00:55 PM
REPRESENTATIVE MCCARTY asked whether federal investigations are
conducted on homes that are not consistent. He further inquired
about what is going on that Alaska is paying back money to the
federal government for noncompliance.
MR. LEE replied that HB 103 does not directly address fraud and
abuse. He deferred to Mr. Baxter and Ms. Lynne Keilman-Cruz to
talk about the department's programs that ensure fraud and abuse
are eliminated wherever found.
4:01:48 PM
LYNNE KEILMAN-CRUZ, Chief of Quality, Division of Senior and
Disabilities Services, Department of Health and Social Services
(DHSS), answered the question on behalf of the House Rules
Standing Committee, sponsor, by request of the governor. She
said the department is required by the federal government to
comply with the settings rule for Alaska's home and community-
based waivers. In conjunction with the Residential Licensing
Section the [Division of Senior and Disabilities Services]
conducts the settings evaluations to make sure folks are
complying. All the current residential homes have gone through
a settings evaluation and found in compliance with the rules as
they are stated now. She said she assumes the same would apply
for folks who are coming into [the division's] services or
becoming certified. For those private homes that are not
certified, the federal rule doesn't apply, but if it were to
become a law and a regulation then the state's rules would apply
for that as well.
REPRESENTATIVE MCCARTY inquired whether homes that do not have
waivered individuals would have to comply with something anyway.
MS. KEILMAN-CRUZ responded that it is to be consistent with
licensing rules and it also a very basic human element for folks
to be able to have visitors of their choosing in the home. So,
it is a federal settings rule, but it is an important human
decency rule.
REPRESENTATIVE MCCARTY acknowledged the respect of someone to
bring anyone or groups of people into their home 24/7, but said
he is thinking of a senior "John Belushi Animal House." He
asked how it plays out when the choices of one person are
intruding on the choices of others.
MS. KEILMAN-CRUZ deferred to the Residential Licensing Section
to respond to the question.
4:05:02 PM
MR. BAXTER answered that this new rule would not prohibit a
facility from having reasonable expectations that visitors and
guests are not disruptive. For example, the expectation that
they would follow any specified quiet hours in the home, and
that they are not up late being loud, disruptive, violent, or
verbally abusive. Any of those things could still be restricted
by the facility. If a resident continued to have disruptive
people over, those individuals could be asked to leave if there
is a documented pattern of disruption. Or, if the people coming
over were unsafe, [the resident's] treatment team and guardian
or care coordinator could work with the facility on having
restricted visits. This would be addressed within [the
resident's] care plan and there would have to be some sort of
documentation that the individuals are disruptive, unsafe, and
impacting other people in the facility. It would be no
different than a facility asking a parent who comes to visit
with an unruly child to refrain from bringing the child. The
division would not look at that as being an unreasonable
restriction to place on that visitation.
4:06:47 PM
REPRESENTATIVE SPOHNHOLZ pointed out that most group homes in
Alaska are private regardless of whether they accept Medicaid
funding. But, she continued, the people living in those homes
have the same rights to liberty as people who live independently
and therefore they should have the right to have their friends
and loved ones visit them when they like, and that the resident
doesn't become a hostage just because he or she lives in a group
home. She concurred that there is a balancing act and a party
at 3:00 a.m. is not a liberty but rather oppression of others in
the household. Representative Spohnholz referenced the
recommendations made in the annual report of Alaska's Office of
Long Term Care Ombudsman for 10/1/20199/30/2020. The
recommendations, she related, include the right to access to the
internet, the right to receive information in a language that
the resident understands, the right to receive meals that are
culturally preferred, and the right to live without fear of
reprisal or retaliation. She asked whether any of these were
considered when drafting HB 103 and, if not, why not.
MR. LEE replied that adding additional requirements was debated.
However, he continued, ensuring that the requirements outlined
in the Code of Federal Regulations (C.F.R.) was wanted, along
with not overly complicating the bill given its critical
importance to ensuring that the state continues to be eligible
to receive the funding through its waiver programs. The
foremost priority was to ensure that [the state's] settings
rules were compliant with 42 CFR and so that was the strategy
chosen.
REPRESENTATIVE SPOHNHOLZ inquired whether the department has any
objection to adding some of those recommendations.
MR. LEE responded that the department would be happy for any
friendly amendments.
4:10:10 PM
CO-CHAIR SNYDER opened public testimony on HB 103.
4:10:25 PM
MICHAEL GARVEY, Advocacy Director, American Civil Liberties
Union (ACLU) of Alaska, testified in support of HB 103. He
stated that ACLU of Alaska is committed to furthering the rights
and dignity of people with disabilities who live in assisted
living facilities. He said his organization supports HB 103
because it will bring the state into compliance with the federal
government's home and community-based services settings rule.
One of the rule's core goals, he continued, is to ensure that
federal funding for home and community-based services flows to
settings that promote true community integration for people with
disabilities and elder Americans. Institutional settings pose a
great risk to the physical and mental well-being of residents,
limit their autonomy, and isolate them from broader society.
MR. GARVEY said ACLU of Alaska is expressing its support because
people with disabilities deserve the same right to make choices,
access the broader community, and interact with the world as
anyone else. Through a simple statutory fix, HB 103 would help
ensure that residents of any assisted living facility are living
in conditions that uphold their privacy, dignity, respect,
agency, and visitation. He added that ACLU of Alaska endorses
the recommendations provided by Alaska's Office of Long Term
Care Ombudsman, which would further promote the dignity of
assisted living facility residents and ensure that they are
connected to the community.
4:12:19 PM
CO-CHAIR SNYDER closed public testimony after ascertaining no
one else wished to testify.
CO-CHAIR SNYDER stated that HB 103 was held over.
SB 21-LICENSE MOBILE INTENSIVE CARE PARAMEDICS
4:12:37 PM
CO-CHAIR SNYDER announced that the final order of business would
be SENATE BILL NO. 21, "An Act relating to mobile intensive care
paramedics; relating to duties of the State Medical Board and
the Department of Health and Social Services; and providing for
an effective date."
4:13:17 PM
SENATOR JOSH REVAK, Alaska State Legislature, as the prime
sponsor, presented SB 21. He reported that licensure oversight
of Alaska's approximately 600 licensed paramedics is currently
split between two separate agencies - the State Medical Board
under the Department of Commerce, Community, and Economic
Development (DCCED), and the Emergency Medical Services Office
under the Department of Health and Social Services (DHSS). He
stated that the purpose of SB 21 is to help Alaska's paramedics
by consolidating the emergency medical service system under a
single agency, DHSS, to improve peer and professional oversight.
Unanimously supported by the State Medical Board, it also has
broad support from first responders and paramedics around the
state.
SENATOR REVAK explained that SB 21 would transfer all paramedic
licensure to the Emergency Medical Services Office. He noted
that, currently, paramedics are the only one of their kind under
DCCED, all other emergency medical services are already under
DHSS, which is responsible for certifying all emergency medical
technicians (EMTs) and intensive care paramedics. The bill
would not change the scope of practice, the licensure
requirements, or the fee structure. The medical direction would
be provided by the existing DHSS Chief Medical Officer and the
EMS Medical Directors Committee. He further noted that the bill
would have zero fiscal impact and that DHSS's existing data
systems are already able to incorporate paramedic licensure,
making the move a seamless transition. Aligning all EMS
services under a single agency would promote public health and
safety, he continued, while also providing efficiencies through
peer and professional oversight. The bill has bipartisan
support and passed unanimously on the Senate floor.
4:15:25 PM
SETH DUGGAN, Staff, Representative Josh Revak, Alaska State
Legislature, provided the sectional analysis for SB 21 on behalf
of Senator Revak, prime sponsor. He paraphrased from the
written document titled, "SECTIONAL ANALYSIS, Senate Bill 21,"
which read [original punctuation provided except for some minor
formatting changes]:
Sec. 1 amends 08.64.107, State Medical Board/
Regulation of physician assistants and intensive care
paramedics, to remove regulation of paramedic
licensure from the Medical Board. (See also Sec. 8.)
Sec. 2 amends 08.64.170(a), License to practice
medicine, podiatry, or osteopathy, allowing paramedics
to practice medicine to render emergency lifesaving
service under "another law" instead of under the
Medical Board's authority. (See also Sec. 6)
Sec. 3 amends 08.64.360, Penalty for practicing
without a license or in violation of chapter, to
remove paramedics. (See also Sec. 10)
Sec. 4 amends 08.64.369(d), Health care professionals
to report certain injuries, to change paramedics
licensed under the Medical Board to those licensed
under DHSS, for health care providers who must report
certain injuries to the Department of Public Safety.
Sec. 5 amends 12.55.185(11), Sentencing and Probation,
to change paramedics licensed under the Medical Board
to those licensed under DHSS.
Sec. 6 amends 18.08.075, Authority of emergency
medical technician, to allow paramedics to provide
emergency medical care. (See also Sec. 2.)
Sec. 7 amends 18.08.080, Emergency Medical Services/
Regulation, to require DHSS to adopt regulations
establishing standards for paramedic licenses.
Sec. 8 adds a new paragraph 18.08.082(a)(5), Issuance
of certificates; designations, to add regulation of
paramedic licensure to DHSS. (See also Sec. 1.)
Sec. 9 amends 18.08.082(b), Issuance of certificates;
designations, to clarify that DHSS is the central
certifying and licensing agency for emergency medical
services.
Sec. 10 amends 18.08.084(a), Certificate required, to
prohibit a person from practicing as a paramedic
without a license. (See also Sec. 3.)
Sec. 11 amends 18.08.086(a), Immunity from liability,
Adding the term license. Provides civil immunity to
licensed or certified emergency medical providers who
are providing emergency medical service. They are not
liable for civil damages unless [it's] gross
negligence.
Sec. 12 18.08.089(a) is amended to clarify a paramedic
is allowed to pronounce someone dead in certain
circumstances.
Sec. 13 adds a new paragraph (14) to 18.08.200,
Emergency Medical Services/Definitions, to add the
definition of "mobile intensive care paramedic". (See
also Sec. 14.)
Sec. 14 Amends 29.45.050(r) to include mobile
intensive care paramedics in a municipal property tax
exemption.
Sec. 15 amends 37.05.146(c)(77)(F), Definition of
program receipts and non-general fund program
receipts, to add fees for licensure of paramedics to
the list of fees collected by DHSS.
Sec. 16 repeals 08.64.366, Liability for services
rendered by a mobile intensive care paramedic (See
Sec. 11, 18.08.086, Immunity from liability, under
DHSS). Repeals 08.64.380, Medicine/Definitions to
remove (3) "emergency lifesaving service" and (4)
"mobile intensive care paramedic" (See also Sec. 13).
Sec. 17 amends the uncodified law to provide
transitional authorities:
(a) A current paramedic license issued before
January 1, 2022 remains valid until it expires
under the Medical Board, is suspended or revoked,
or is converted to a license under DHSS.
(b) The Department of Commerce, Community and
Economic Development and the Medical Board will
transfer to DHSS on January 1, 2022, files of all
pending paramedic-related records and
proceedings, applications, and disciplinary
actions.
(c) Authority for DHSS to adopt regulations which
shall include the conversion of unexpired
paramedic licenses issued under the Medical
Board.
Sec. 18 provides an immediate effective date for DHSS
to adopt regulations.
Sec. 19 provides an effective date of January 1, 2022.
4:18:45 PM
REPRESENTATIVE SPOHNHOLZ noted that most of the licensing for
health care professionals is done in DCCED. She remarked that
there seems to be an exception here, wherein SB 21 is seeking to
consolidate licensure for EMTs and paramedics into one spot.
She asked why [the sponsor] chose to go with DHSS rather than,
for example, staying with DCCED and creating a new board.
SENATOR REVAK answered that all the EMS services are already
housed under one roof within DHSS. The split between the two
occurred at the time when intensive care mobile paramedics were
created, and [this split] has caused some significant challenges
to licensure. So, [consolidating EMTs and paramedics] is a
cleanup measure.
REPRESENTATIVE SPOHNHOLZ said she understands the rationale for
moving paramedics from under the Medical Board. It used to be
that everything was under the Medical Board, she continued, but
now it has been realized that health care providers who have
different expertise can regulate and manage their own licensure,
and paramedics should be allowed to do that. However, she
pointed out, most licensure in the state of Alaska is done in
DCCED and the choice is being made here to move paramedics under
DHSS as opposed to moving EMTs under DCCED. She inquired about
the rationale for doing that.
SENATOR REVAK deferred to the agency to answer the question.
4:21:58 PM
BRIAN WEBB, Emergency Medical Services Officer, Division of
Public Health, Department of Health and Social Services (DHSS),
noted he is one of a remaining few who were on the ground at the
time this whole thing was started. He stated that there are no
emergency medicine or paramedical subject matter experts in
DCCED, plus emergency medicine and paramedical professionals do
not have much input into changing regulations for their craft.
So, paramedics always seem to be left behind. However, the
Emergency Medical Services Office, with all its in-house
paramedics, would have the ability to develop and change
regulations and keep up to date with new procedures in the
craft. Changes to education requirements, standards, and
procedures are easily done within the Emergency Medical Services
Office, yet it is exceedingly hard to do for the Medical Board.
[Paramedics] have tried for years to have a seat on the Medical
Board because there are over 655 paramedics in Alaska. However,
[paramedics] have been repeatedly told they will not have a seat
on the Medical Board because that would mean somebody else would
have to give up a seat. One reason why [paramedics] have
requested this, Mr. Webb continued, is to have some control over
their craft and their future. Another impetus comes from the
2014 National Highway Transportation Safety Administration's
(NHTSA's) reassessment of emergency medical services in Alaska,
which recommended that the Alaska State Legislature transfer the
licensing of paramedics from the State Medical Board to DHSS. A
footnote to this recommendation, he added, is that only four
states have a similar regulatory split; most states have their
personnel under their semblance of an Emergency Medical Services
Office.
REPRESENTATIVE SPOHNHOLZ said she understands the issue of
wanting to move out from underneath the State Medical Board it
doesn't make any sense that paramedics be licensed and decisions
about licensing for paramedics be done by the State Medical
Board, particularly if there isn't space for paramedics to sit
on that board. But, she continued, most of the other health
care practitioners have their own boards that are made up of
peers of their own choosing and they make the regulations and
licensing standards, and they sit under DCCED's Division of
Corporation, Business, and Professional Licensing. All other
health care items, health care licensing and facility licensing,
sit at DHSS, but the practitioners themselves are governed,
licensed, and managed under DCCED. She asked whether
consideration was given to creating a board of paramedics that
was made up of paramedics and which would be responsible for
managing licensure under the DCCED.
4:26:07 PM
SARA CHAMBERS, Director, Division of Corporation, Business, and
Professional Licensing, Department of Commerce, Community, and
Economic Development (DCCED), replied that the bill was
originally, and continues to be, presented not as a "let's solve
a problem with a variety of options;" rather, this is the
proposal. She stated that the division did not explore deeply
the idea of creating a new board, or proposing that the
legislature create a new board, because DHSS is already so well
resourced and already has all the staff and the programming set
up for emergency services that it didn't make sense from an
efficiency standard to try to recreate that or something similar
on DCCED's side. She said DCCED's model of governance through a
board is very different than the EMS management model with
paramedics already on staff who are working to govern those
regulations through the public process. Of these two processes,
DHSS is far better resourced than DCCED to provide the value to
paramedics and consistency with the [Emergency Medical Services
Office].
REPRESENTATIVE SPOHNHOLZ asked whether paramedics are governed,
regulated, and licensed this same way in other states or whether
paramedics tend to sit in the same department as nurses,
physician assistants, doctors, and other health care providers.
MR. WEBB responded that four states have this same split and are
currently trying to solve that as well. Therefore, the majority
are through their semblance of a state EMS office. In further
response, he agreed to provide written details.
4:29:27 PM
CO-CHAIR SNYDER opened public testimony on SB 21.
4:29:48 PM
WILMA VINTON, testified in support of SB 21. She related that
she is the assistant chief of EMS for the state's volunteer fire
department, which is responsible for ensuring that folks are
certified, and she is also an instructor for the State of Alaska
and teaches many EMTs throughout the Interior. She said she
assists EMTs and Mobile Intensive Care Paramedics (MICPs) with
acquiring and maintaining their certifications and licensure.
She stated she has personally gone through both processes, first
becoming certified as an EMT in Alaska from Montana in 1979 and
then becoming an MICP in 2007, and it is her opinion that moving
from the State Medical Board to the Emergency Medical Services
Office in DHSS is an excellent way to streamline the licensing
and certification process.
MS. VINTON pointed out that EMTs and MICPs work side by side,
yet certification and recertification requires working with two
different agencies and two different processes. She said the
Emergency Medical Services Office currently certifies EMTs
within 7-20 days of testing, and she doesn't see a problem with
MICPs being licensed in the same timeline. Currently, the MICP
licensing process under the State Medical Board can take several
months because the board only meets quarterly to approve
licenses, causing a backup in receiving certifications and
licenses. The Emergency Medical Services Office, however, has
staff whose daily job is to provide licensing and certification.
They have honed the process and will be as thorough as the State
Medical Board's process, albeit in a shorter amount of time.
This shortened timeframe is important to someone who is trying
to get a paramedic job in Alaska. Ms. Vinton offered her strong
belief that it would be a seamless move and would align the
MICPs with EMS like in many other states. She concluded by
urging the committee to support SB 21.
4:33:01 PM
CO-CHAIR ZULKOSKY offered her understanding that SB 21 would
create an intensive care paramedic in addition to an EMT.
SENATOR REVAK replied that it doesn't create a new one, it moves
the paramedics from DCCED over to DHSS with the rest of EMS.
SENATOR REVAK returned to an earlier question by Representative
Spohnholz and explained that when initially looking at this
problem this seemed to be the easiest path that made the most
sense since EMS is already running seamlessly under DHSS.
4:34:15 PM
CO-CHAIR SNYDER closed public testimony on SB 21.
CO-CHAIR ZULKOSKY asked whether adopting this legislation would
have any downstream impacts for people who are currently
paramedics in Alaska.
SENATOR REVAK responded that SB 21 should not affect the scope
of service in any way.
MS. CHAMBERS responded that DCCED has pledged to DHSS that it
would be a seamless transition and there are no proposed or
anticipated changes other than to potentially receive augmented
services through the new department. She said DCCED is working
behind the scenes to make this as coordinated as possible.
REPRESENTATIVE MCCARTY expressed his support for SB 21.
[SB 21 was held over.]
4:38:15 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:38 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 103 Transmittal Letter 2.17.21.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Sectional Analysis Version GH 1675 A.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Version 32-GH1675 A.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB0103 Fiscal Note 1-2-021821-DHS-N.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Additional Information - Final Rule 42 CFR 441.301c.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Additional Information - HCBS Transition Plan (DHSS).pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Hearing Request.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Letter of Support - All Ways Caring.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| 09 HB 103 Letter of Support - LTCO 3.16.21.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 One Page Summary (003).pdf |
HHSS 4/13/2021 3:00:00 PM |
HB 103 |
| HB 103 Final Rule 42 CFR 441.301c.pdf |
HHSS 4/13/2021 3:00:00 PM |
HB 103 |
| HB 103 FAQ on Final Rule prepared by Coalition for Community Choice.pdf |
HHSS 4/13/2021 3:00:00 PM |
HB 103 |
| HB 103 Additional Information - Final Rule 42 CFR 441.301c.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Additional Information - One Page Summary by SDS.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/18/2021 3:00:00 PM |
HB 103 |
| HB 103 Letter of Support - ACoA 3.8.21.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/25/2021 3:00:00 PM |
HB 103 |
| HB 103 Letter of Support - Colony Assisted Living Home 3.24.21.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 3/25/2021 3:00:00 PM |
HB 103 |
| HB 103 Letter of Support - MSHF 3.26.21.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 4/1/2021 3:00:00 PM |
HB 103 |
| HB 103 Letter of Support - AK Regional Hospital 3.26.21.pdf |
HHSS 4/13/2021 3:00:00 PM HSTA 4/1/2021 3:00:00 PM |
HB 103 |
| SB 89 AARP Support HB103 and SB89.pdf |
HHSS 4/13/2021 3:00:00 PM HHSS 4/29/2021 3:00:00 PM SFIN 4/7/2021 9:00:00 AM |
HB 103 SB 89 |
| SB 21 version B.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Sponsor Statement.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Fiscal Note DHSS.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Fiscal Note DCCED.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Sectional Analysis.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Point Paper.pdf |
HHSS 4/13/2021 3:00:00 PM SHSS 3/2/2021 1:30:00 PM |
SB 21 |
| SB 21 Updated Sectional Analysis 3.1.21.pdf |
HHSS 4/13/2021 3:00:00 PM |
SB 21 |
| SB 21 v. B Sectional Analysis.pdf |
HHSS 4/13/2021 3:00:00 PM SL&C 3/15/2021 1:30:00 PM |
SB 21 |
| SB 21 v. B.pdf |
HHSS 4/13/2021 3:00:00 PM SL&C 3/15/2021 1:30:00 PM |
SB 21 |
| HB 168 Sectional Analysis, Ver W..pdf |
HHSS 4/13/2021 3:00:00 PM |
HB 168 |
| HB 168, Ver W..PDF |
HHSS 4/13/2021 3:00:00 PM |
HB 168 |
| HB 168 Sponsor Statemen.pdf |
HHSS 4/13/2021 3:00:00 PM |
HB 168 |