Legislature(1995 - 1996)

02/15/1996 08:04 AM House STA

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
             HOUSE STATE AFFAIRS STANDING COMMITTEE                            
                       February 15, 1996                                       
                           8:04 a.m.                                           
 MEMBERS PRESENT                                                               
 Representative Jeannette James, Chair                                         
 Representative Scott Ogan, Vice Chair                                         
 Representative Joe Green                                                      
 Representative Ivan Ivan                                                      
 Representative Brian Porter                                                   
 Representative Caren Robinson                                                 
 Representative Ed Willis                                                      
 MEMBERS ABSENT                                                                
 Representative Ivan Ivan                                                      
 COMMITTEE CALENDAR                                                            
 * HOUSE BILL NO. 432                                                          
 "An Act relating to the practice of veterinary medicine."                     
      - PASSED FROM COMMITTEE                                                  
 * HOUSE BILL NO. 384                                                          
 "An Act relating to payment requirements for retention in the                 
 Pioneers' Home; and providing for an effective date."                         
      - PASSED FROM COMMITTEE                                                  
 * HOUSE BILL NO. 463                                                          
 "An Act establishing restrictions on certain regulatory                       
      - SCHEDULED BUT NOT HEARD                                                
 * HOUSE BILL NO. 63                                                           
 "An Act relating to special request licenses depicting the sport of           
 dog mushing."                                                                 
      - SCHEDULED BUT NOT HEARD                                                
 HOUSE BILL NO. 405                                                            
 "An Act relating to the Board of Examiners in Optometry; relating             
 to licensure of dispensing opticians; and providing for an                    
 effective date."                                                              
      - CANCELLED FOR THIS DATE                                                
 HOUSE BILL NO. 457                                                            
 "An Act relating to the unlicensed practice of certain occupations            
 for which licenses are required."                                             
      - CANCELLED FOR THIS DATE                                                
 PREVIOUS ACTION                                                               
 BILL:  HB 432                                                               
 SHORT TITLE: VETERINARY LICENSING                                             
 SPONSOR(S): LABOR & COMMERCE                                                  
 JRN-DATE      JRN-PG            ACTION                                        
 01/19/96      2484    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 01/19/96      2485    (H)   STATE AFFAIRS, LABOR & COMMERCE                   
 02/15/96              (H)   STA AT 08:00 AM CAPITOL 102                       
 BILL:  HB 384                                                               
 SHORT TITLE: PIONEERS' HOME - INABILITY TO PAY                                
 SPONSOR(S): REPRESENTATIVE(S) ROKEBERG                                        
 JRN-DATE      JRN-PG            ACTION                                        
 12/29/95      2366    (H)   PREFILE RELEASED                                  
 01/08/96      2367    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 01/08/96      2367    (H)   STATE AFFAIRS, HES, FINANCE                       
 02/15/96              (H)   STA AT 08:00 AM CAPITOL 102                       
 WITNESS REGISTER                                                              
 GEORGE DOZIER, Legislative Assistant                                          
    to Representative Pete Kott                                                
 State Capitol, Room 432                                                       
 Juneau, Alaska 99801-1182                                                     
 Telephone:  (907) 465-3777                                                    
  POSITION STATEMENT:   Provided sponsor statement for HB 432.                 
 CATHERINE REARDON, Director                                                   
 Central Office                                                                
 Division of Occupational Licensing                                            
 Department of Commerce and Economic Development                               
 P.O. Box 110806                                                               
 Juneau, Alaska 99811-0806                                                     
 Telephone:  (907) 465-2534                                                    
  POSITION STATEMENT:   Provided testimony on HB 432.                          
 REPRESENTATIVE NORMAN ROKEBERG                                                
 Alaska State Legislature                                                      
 State Capitol, Room 110                                                       
 Juneau, Alaska 99801-1182                                                     
 Telephone:  (907) 465-4968                                                    
  POSITION STATEMENT:   Sponsor of HB 384.                                     
 ANN JANZEN                                                                    
 P.O. Box 6205                                                                 
 Sitka, Alaska 99835                                                           
 Telephone:  (907) 747-6398                                                    
  POSITION STATEMENT:   Provided testimony in favor of HB 384.                 
 JAMES KOHN, Deputy Director                                                   
 Pioneers' Home Central Office/Advisory Board                                  
 Division of Senior Services                                                   
 Department of Administration                                                  
 P.O. Box 110211                                                               
 Juneau, Alaska 99811-0211                                                     
 Telephone:  (907) 465-4400                                                    
  POSITION STATEMENT:   Provided testimony on HB 384.                          
 ACTION NARRATIVE                                                              
 TAPE 96-16, SIDE A                                                            
 Number 0000                                                                   
 The House State Affairs Committee was called to order by Chair                
 Jeannette James at 8:04 a.m.  Members present at the call to order            
 were Representatives Porter, Robinson, Willis, Green and James.               
 Members absent were Representatives Ogan and Ivan.                            
 CHAIR JEANNETTE JAMES announced Representative Ivan Ivan was at a             
 sub-committee meeting.                                                        
 HB 432 - VETERINARY LICENSING                                               
 The first order of business to come before the House State Affairs            
 Committee was HB 432.                                                         
 CHAIR JAMES called on George Dozier, Legislative Assistant to                 
 Representative Pete Kott to present the sponsor statement for HB
 Number 0085                                                                   
 GEORGE DOZIER, Legislative Assistant to Representative Pete Kott,             
 said HB 432 was suggested by a local veterinarian in Eagle River              
 who felt the definition of the unauthorized practice of                       
 veterinarian medicine was too vague.  It was also discovered the              
 licensing statutes referenced examinations administered by the                
 National Board of Veterinary Medical Examiners and the American               
 Veterinary Association's Education Commission for Foreign                     
 Veterinary Graduates that no longer administered them.                        
 Consequently, the House Labor and Commerce Committee filed HB 432.            
 Mr. Dozier said it was a relatively simple bill.  The bill                    
 substituted the names of the examinations to bring the current                
 statutes into conformity with actual examination practices.  He               
 cited the examinations were now administered by the National Board            
 Examination Committee and the National Board Examination                      
 Committee's Education Commission for Foreign Veterinary Graduates.            
 He further said HB 432 defined the nature of unlicensed veterinary            
 practice for the state of Alaska and made it a criminal penalty -             
 a unclassified misdemeanor with a potential penalty of up to one              
 year in jail and a $10,000 fine.  The bill also required veterinary           
 technicians be licensed by the state.  He said there were                     
 veterinarians standing by in Anchorage to articulate their                    
 Number 0302                                                                   
 CHAIR JAMES wondered about veterinary medicine in general, and                
 questioned if the bill prohibited dog mushers, for example, from              
 giving shots to their own dogs.                                               
 Number 0350                                                                   
 MR. DOZIER replied the bill was intended to not affect individuals            
 who cared for their own animals, but rather for individuals who               
 held themselves as a competent animal caregiver.                              
 Number 0368                                                                   
 CHAIR JAMES replied, therefore, a dog musher such as Susan Butcher            
 could take care of her own dogs, but she could not take care of               
 anybody else's dog.                                                           
 Number 0406                                                                   
 MR. DOZIER said, "I don't believe that that's the intent of the               
 CHAIR JAMES mentioned farmers who took care of their own animals.             
 She also mentioned artificial insemination, and wondered if a                 
 farmer could perform such a service.                                          
 MR. DOZIER replied, "I don't believe that it would have to be a               
 veterinarian, Madame Chair."                                                  
 Number 0414                                                                   
 CHAIR JAMES further wondered about pet shops that sold animals                
 without a check-up, and questioned if there was a law that                    
 prohibited that.                                                              
 Number 0470                                                                   
 MR. DOZIER said he did not know definitively if there a law that              
 prohibited a pet shop from selling diseased animals.  The intent of           
 HB 432, however, was to prohibit the unauthorized practice of                 
 veterinarian medicine, he asserted.                                           
 Number 0505                                                                   
 REPRESENTATIVE CAREN ROBINSON mentioned the problems regarding the            
 humane societies and the ability to give the appropriate shots.               
 She suggested Mr. Dozier look into that matter further.                       
 Number 0549                                                                   
 CHAIR JAMES said she was concerned about the cost getting too high            
 for the benefits to a society, such as the humane society.                    
 Number 0577                                                                   
 REPRESENTATIVE BRIAN PORTER questioned if the restrictions should             
 be placed on a person that performed the service for money rather             
 than a person that performed it for free.  He said he did not want            
 his neighbor who helped his dog with its broken leg to commit a               
 Number 0612                                                                   
 CHAIR JAMES responded she remembered when it was illegal to cut               
 somebody else's hair in the state of Oregon.  The act did not                 
 delineate between a service charge or not.  It was protectionism              
 for the barbers and hairdressers.                                             
 Number 0660                                                                   
 MR. DOZIER referred the committee members to Section 7 which                  
 indicated the practice of veterinary medicine did mean for                    
 Number 0674                                                                   
 REPRESENTATIVE JOE GREEN said the questions had gone askew.  The              
 focus of HB 432 dealt with the practice of veterinarian medicine              
 and not what friends did for each other.  He suggested keeping the            
 focus on the practice of veterinarian medicine.                               
 Number 0728                                                                   
 REPRESENTATIVE ROBINSON suggested hearing from Catherine Reardon,             
 Department of Commerce and Economic Development, to explain the               
 lack of a zero fiscal note from the department.                               
 Number 0817                                                                   
 CATHERINE REARDON, Director, Central Office, Division of                      
 Occupational Licensing, Department of Commerce and Economic                   
 Development, said a fiscal note was not submitted because it was              
 not requested.  She said it would be a zero fiscal note from the              
 department and she would be happy to prepare one for the committee.           
 CHAIR JAMES replied, "it would be appreciated."                               
 Number 0840                                                                   
 REPRESENTATIVE ROBINSON questioned the zero fiscal note because the           
 bill stated the department would be setting up regulations, and               
 wondered if staff existed already.                                            
 Number 0856                                                                   
 MS. REARDON replied the department had a regulation specialist and            
 the projects would compete with each other.  She stated there would           
 be advertising, and if the committee wanted, she could include the            
 public interest cost, but the department would generally absorb it            
 like any other regulation project.                                            
 Number 0889                                                                   
 REPRESENTATIVE ROBINSON wondered if this was a conformation to a              
 new law because it sounded like a lot of it was already in place.             
 MS. REARDON replied HB 432 was a clean-up of the existing statute.            
 Number 0909                                                                   
 CHAIR JAMES stated the bill added veterinary technicians.                     
 MS. REARDON replied the bill allowed the board to adopt                       
 regulations.  The board currently licensed veterinary technicians,            
 but did not have the regulatory authority.  She stated the bill               
 improved the system.                                                          
 REPRESENTATIVE ROBINSON moved that HB 432 move from the committee             
 with individual recommendations and zero fiscal notes including the           
 commitment from Catherine Reardon to provide a zero fiscal note               
 from the Department of Commerce and Economic Development.  Hearing            
 no objection, HB 432 was moved from the House State Affairs                   
 HB 384 - PIONEERS' HOME - INABILITY TO PAY                                  
 The next order of business to come before the House State Affairs             
 Committee was HB 384.                                                         
 CHAIR JAMES called on the sponsor of HB 384, Representative Norman            
 Number 1025                                                                   
 REPRESENTATIVE NORMAN ROKEBERG read the following statement into              
 the record.                                                                   
 "HB 384 gives statutory protection to what has been the standard              
 policy since the beginning of the Pioneers' Homes in Alaska -- that           
 residents who cannot pay are not evicted.  HB 384 will provide a              
 statutory safety net that prevents the state from evicting                    
 "Currently 86 out of the 603 residents in the states' six Homes               
 cannot pay the full rent.  Since significant annual rate increases            
 have been proposed by the governor, many of the residents are                 
 living in fear of the consequences if they cannot afford the                  
 proposed rates."                                                              
 REPRESENTATIVE ROKEBERG diverted from his sponsor statement to                
 mention his mother was a member of the Anchorage Pioneer Home.  He            
 stated she was 84 years old and had lived there for about 3 years.            
 As a result of visiting her, it came to his attention that the                
 residents were very frightened of their future.  He said he saw               
 fear in the faces of the residents because they lived on modest               
 incomes.  He referred the committee members to the fee schedule               
 illustrating the estimated monthly cost from the state of $3,862              
 while the present monthly cost was $860.  He further stated the               
 concept of the Alaska Pioneers' Homes had changed.  The residents             
 were older now because of the desire to stay in their homes.                  
 Therefore, the range of care had changed also.  He stated, less               
 than 20 percent to 25 percent of the residents were actually at a             
 residential level.  The assisted living style had increased to the            
 Alzheimer's Disease and Related Disabilities (ADRD) level.  He said           
 the Alaska Pioneers' Homes were the only institutions that provided           
 a place for alzheimer patients.  He further stated the fee schedule           
 was adjusted by the Governor.  He cited the first year went from              
 $860 to $1,288 or a 50 percent increase.  The next year was 33                
 percent, and further cited 25 percent, 17 percent, 14 percent and             
 11 percent increases for the next 7 years.  He referred the                   
 committee members to a memorandum dated January 25, and read                  
 "unwritten policies should be set out in either statute regulation            
 or department policy and procedure manuals so that the affected               
 members of the public were informed of the policies and procedures            
 that applied to them when dealing with a state agency."                       
 Number 1351                                                                   
 CHAIR JAMES said she had watched the struggle for four years now on           
 how the Pioneers' Homes would be financed.  She wondered how the              
 burgeoning cost would be dealt with after HB 384.  She cited                  
 medicaid/medicare funds as a possibility.                                     
 Number 1384                                                                   
 REPRESENTATIVE ROKEBERG said he was on a sub-committee with                   
 Representative Robinson that addressed legislation to privatize the           
 Pioneers' Homes.  He stated, as a result of a work session in                 
 Anchorage this summer, HB 384 was introduced.  The main thrust of             
 the before mentioned bill was to determine how the cost would                 
 impact the budget, and the attempt to privatize the Pioneers' Homes           
 was an option.  The bill was tabled because there was not a market            
 to buy these homes based on the testimony.  He further stated                 
 because of legal challenges the resident requirements went from 15            
 years to 1 year, and consequently there was a huge pool of people,            
 and a wait list option was now available as well.  He cited there             
 were over 300 people on the waiting list.  He stated the medigrant            
 program being discussed in Congress obviated the problem by taking            
 money out of one pocket and putting it into another.  The federal             
 government paid 50 percent of the medicaid amounts now, therefore,            
 those that qualified for medicaid, the state would get that 50                
 percent, while the block grant created a finite amount of money.              
 He further commented the language change in the committee                     
 substitute allowed the resident to determine how much he or she               
 paid, or provided a loop hole in the original bill.  He said the              
 language in the original bill was not tight enough.                           
 Number 1561                                                                   
 REPRESENTATIVE PORTER commented the original intent of the                    
 Pioneers' Homes had been subverted.  He said he was sympathetic               
 towards the current residents because they entered with certain               
 expectations.  He further stated HB 384 affected subsequent                   
 residents, and felt it was not appropriate for future residents to            
 transfer their assets so that the state had to take care of them              
 for the rest of their lives.                                                  
 Number 1640                                                                   
 REPRESENTATIVE ROKEBERG replied Representative Porter was referring           
 to the spending-down phenomena common among the elderly to qualify            
 for medicaid.  He said he discovered there was a law on the book in           
 the state of Alaska that required a child to be responsible for the           
 debts of his or her parents.  He stated Representative Porter made            
 an excellent point, and fraudulent spending needed to be addressed            
 further.  He said he did not intend to address it today before the            
 House State Affairs Committee because it was such a major problem.            
 Number 1714                                                                   
 REPRESENTATIVE PORTER said he was concerned about the elderly that            
 intentionally tried to defraud the state.  However, he agreed at              
 some point, the state would have to eat a certain percentage of the           
 cost, but according to HB 384 that would not happen.                          
 Number 1750                                                                   
 REPRESENTATIVE ROKEBERG replied he did not understand exactly what            
 Representative Porter said.  The state had a contractual and legal            
 obligation once it accepted a resident into a Pioneers' Home.                 
 Number 1787                                                                   
 REPRESENTATIVE PORTER said he would vote for HB 384 if it said                
 "existing residents."  However, he stated, he could not support the           
 bill if it affected every future resident because it was a gigantic           
 loop hole.                                                                    
 Number 1816                                                                   
 CHAIR JAMES wondered about the future, 20 years from now.  She                
 stated she did not want to bind the future to anything that the               
 state would not be able to follow-up on.  She said she had no                 
 problem protecting the current resident, but the long-term                    
 commitment made her nervous.                                                  
 Number 1864                                                                   
 REPRESENTATIVE ROKEBERG stated he would like to get the departments           
 reaction regarding the new entry.  He reiterated, when a resident             
 entered the Pioneers' Homes, the state was obligated.  He said he             
 did not care if it was tomorrow or 20 years from now, the state was           
 obligated.  He stated future administrators and legislators might             
 sell, dispose of, or consolidate the Pioneers' Homes, for example.            
 The state would still be obligated even if it were to pay to                  
 transfer that patient to a new home.                                          
 Number 1919                                                                   
 CHAIR JAMES replied the residents should know what they were faced            
 with when entering the Pioneers' Homes.  She agreed a commitment              
 should be followed through with, but she was concerned about the              
 bigger problem.  She stated, her biggest fear was that no matter              
 how hard the state tried, it would not happen.                                
 Number 1947                                                                   
 REPRESENTATIVE JOE GREEN stated an open checkbook would cover                 
 future residents with less assets.  He alleged HB 384 would force             
 closure due to budget cuts and cited the longevity bonus program as           
 a similar example.  He further said he was concerned about the zero           
 fiscal note.  He stated somewhere the cost needed to be covered,              
 and asserted he could not support HB 384 until it stayed within the           
 objective of the legislature to cut the budget.                               
 Number 2009                                                                   
 REPRESENTATIVE SCOTT OGAN replied the zero fiscal note reflected              
 the current policy, therefore, HB 384 would not increase the cost.            
 REPRESENTATIVE GREEN replied no effort was shown how to cover the             
 Number 2036                                                                   
 REPRESENTATIVE ROBINSON said the intent of HB 384 was wonderful.              
 The House State Affairs Committee members agreed that under no                
 circumstances they wanted the residents today to fear they would be           
 kicked-out.  She further stated she agreed with Representative                
 Rokeberg that there was a tendency every year to change the                   
 policies.  Therefore, every resident deserved the same right even             
 though they were admitted last week, for example.  She asserted the           
 state would take on some responsibility due to the ADRD residents.            
 Number 2104                                                                   
 REPRESENTATIVE PORTER said he agreed with Representative Robinson's           
 position, and suggested drafting language to prevent future                   
 eviction, if the cost increased since the original entrance.  He              
 commented HB 384 was too much.                                                
 Number 2134                                                                   
 CHAIR JAMES said she agreed with Representative Robinson's premise            
 of her statement.  She further stated there was not enough room in            
 the Pioneers' Homes to accommodate those that would qualify for the           
 services.  She wondered about expanding the Pioneers' Homes and               
 suggested privatization as an example.  However, she wondered who             
 would privatize a "loser" due to insufficient funds.  She said this           
 was a serious issue.  She stated, if the original intent of the               
 Pioneers' Homes was followed, this would not be an issue.  She                
 agreed the needs were the same, but if it were opened up to                   
 everybody, the public might not be willing to pay for it.  She                
 cited this was very distressing to discuss, but the state needed to           
 be realistic.  She stated she liked the idea and would like to see            
 it in the big picture.  She further stated HB 384 put the                     
 contractual position of the Pioneers' Homes into a statute, so that           
 it would operate no other way, except the existing way.                       
 Number 2280                                                                   
 REPRESENTATIVE ROKEBERG suggested hearing the balance of the                  
 testimony before debating the bill.  He said there were statutes              
 and procedures in place to overcome some of the concerns raised by            
 the House State Affairs Committee.  He stated the 603 residents of            
 the Pioneers' Homes were looking to the legislature for some                  
 assurance for their future, and that was the intention of HB 384.             
 The intent was not to rewrite the entire state policy regarding the           
 Pioneers' Homes.                                                              
 Number 2310                                                                   
 CHAIR JAMES replied she understood the intent of HB 384.  She                 
 further stated it was good for the teleconference witnesses to                
 listen to the concerns of the House State Affairs Committee before            
 they provided their testimony to allow for rebuttal.                          
 CHAIR JAMES called on the next witness via teleconference in Sitka,           
 Ann Janzen.                                                                   
 Number 2350                                                                   
 ANN JANZEN said she and her husband were residents of the Sitka               
 Pioneers' Home due to her husband's health.  She thanked the state            
 of Alaska because her husband was alive today because of the home.            
 She also thanked Representative Rokeberg for introducing HB 384.              
 She cited HB 246 was introduced last year and increased the anxiety           
 level, and blood pressure of the residents in Sitka.  She said if             
 the rates jumped the residents would not be able to pay.  Ms.                 
 Janzen suggested looking at the issue of asset transfer.  She                 
 further said the committee did not need to worry about a flood of             
 people moving to Alaska to enter the Pioneers' Homes.  She                    
 commented seniors would probably move south if the rates increased.           
 She did not want to put that pressure on her children even if it              
 meant she did not live quit as well.  She said she was grateful to            
 the state and happy to be an Alaskan.                                         
 Number 2420                                                                   
 CHAIR JAMES said she supported families and seniors staying                   
 together for the quality and extension of life, 100 percent.  She             
 thanked Ms. Janzen for her testimony.                                         
 CHAIR JAMES called on the next witness in Juneau, James Kohn.                 
 Number 2445                                                                   
 JAMES KOHN, Deputy Director, Pioneers' Homes Central                          
 Office/Advisory Board, Division of Senior Services, Department of             
 Administration, said the division and department supported HB 384             
 for the same reasons Representative Rokeberg stated.  Historically,           
 this was the procedure for caring for the residents.  He cited from           
 1913 to 1990 indigent applicants were given admittance preference             
 over non-indigents.  In 1990 the legislature changed it so that               
 indigents were no longer given preference, resulting in a rate                
 increase.  The Governor's advisory board toured the homes in                  
 September of 1995 and talked to the residents about raising the               
 rates to a cost of care over a period of time.  The residents                 
 feared they would be evicted if they could not pay the rate.                  
 Therefore, HB 384 spoke to that fear.                                         
 MR. KOHN further stated many of the opinions expressed today were             
 not supported by facts.   He stated 95 percent of the people on the           
 waiting list had been in Alaska for over 15 years.  Furthermore,              
 boat loads of people were not coming to Alaska to get on the                  
 waiting list.  The homes were still serving the same people as in             
 the past, he alleged.  Moreover, the statistics indicated people              
 were born in Alaska to be elderly.  He cited Alaska was the least             
 state in the union where the elderly stayed in the state, and                 
 overall there was an out-migration of the elderly.  He further                
 stated the mission of the Pioneers' Homes had changed from a                  
 residential to an assisted living program whereby 80 percent of the           
 residents had needs based on ADRD.  He cited the Sourdough Unit at            
 Harbor View was being closed and programs were being developed to             
 accommodate their special needs and treatments.  Mr. Kohn stated              
 alzheimer patients were increasing and somebody had to pay for that           
 care.  Currently, the home asked the residents to pay as much as              
 they could based on their income and assets.  He cited in FY96 the            
 home collected $5.2 million in revenue from the resident.  The plan           
 was to collect $7.9 million in FY97.  He further stated statistics            
 indicated the home would collect between $9 million to $17 million            
 out of a total budget of $30 million.  He asserted the home was               
 trying to reduce the liability of the state and increase direct               
 payment.  He said medicare and medicaid did not cover patients with           
 ADRD in Alaska.  He also suggested retaining the one year residency           
 requirement to void participation in the federal programs.  He                
 further said block grants did not guarantee more money.  He cited             
 there were 600 beds and currently 300 people on the active waiting            
 list.  However, many did not want to come in right away so the wait           
 had decreased to about 1.5 years.                                             
 TAPE 96-16, SIDE B                                                            
 Number 0369                                                                   
 CHAIR JAMES said in 1991 or 1992 only 40 percent of the senior that           
 collected the longevity bonus had been in the state for three years           
 or less.  She did not begrudge children bringing their parents to             
 the state.  She wondered if it would be dangerous to get rid of the           
 one year residency.                                                           
 Number 0425                                                                   
 MR. KOHN replied many of the seniors, according to their                      
 applications, had left the state and returned.  They left when they           
 were young and hardy then returned in need to their family.  He               
 further stated the medicare/medicaid issue was complex.  He said              
 medicare/medicaid covered skilled nursing care and the Pioneers'              
 Homes never did skilled nursing care compared to other long-term              
 care facilities.  The home was moving towards complete assisted               
 living care because of ADRD.  He cited a social model was very                
 helpful and presently not supported by medicare or medicaid.                  
 Number 0524                                                                   
 CHAIR JAMES wondered if the acceleration of cost caused the                   
 residents to run out of money sooner.                                         
 Number 0533                                                                   
 MR. KOHN replied, "yes."  Currently, 87 residents did not pay the             
 full cost of care.  He cited after the last rent increase the                 
 number of residents who could not pay the full cost of care went              
 from 71 to 87.  A running tally of the bill to the state was also             
 kept and if the resident came into money or passed away the estate            
 was attached to the tally.                                                    
 Number 0590                                                                   
 REPRESENTATIVE PORTER asked if that policy was in a statute.                  
 MR. KOHN replied, "yes."                                                      
 Number 0599                                                                   
 CHAIR JAMES asked what it took to get on the waiting list.                    
 Number 0603                                                                   
 MR. KOHN replied it took a statement of qualification of residency.           
 The active waiting list required a certificate of need based on               
 disability.  A physician's history and physical was also required             
 to validate and assess the need.                                              
 Number 0649                                                                   
 CHAIR JAMES responded an person just needed to apply and the home             
 pigeon holed the applications accordingly.  Therefore, payment                
 information was voluntary.  She wondered if more applicants were              
 applying based on their ability to pay.                                       
 Number 0685                                                                   
 MR. KOHN said people applied because of the mission towards ADRD              
 care.  He stated, the applicants were very willing to pay the rates           
 for the care.                                                                 
 Number 0710                                                                   
 REPRESENTATIVE GREEN suggested looking at moving towards a quasi-             
 medical care facility rather than a pioneer home.  He asked Mr.               
 Kohn what the projected resident would be like in 10 years.                   
 Number 0830                                                                   
 MR. KOHN said he could not project 10 years, but in 3 to 5 years              
 the majority of the residents would be more incapacitated and in              
 need of ADRD care.  He cited the assisted living legislation that             
 would accommodate low level ADRD cases.  The mission of the                   
 Pioneers' Homes, he stated, was to take those individuals that                
 exceeded the resources of their family and the community.  He                 
 described an individual that could not pay was probably demented,             
 and did not have funds, and wondered where that individual would              
 go.  He reiterated the home asked the residents to pay as much as             
 they could, and the state subsidized the rest.                                
 Number 0996                                                                   
 CHAIR JAMES replied it appeared the only solution to the Pioneers'            
 Homes was to continue to fund with state revenue.  Therefore, this            
 must be factored into the long-term planning.  The state made an              
 obligation that it could not get out of.  She said she did not                
 necessarily buy that agreement because there were other funding               
 sources.  She mentioned the struggle of paying for a government               
 service and suggested an exercise to determine the best way to                
 provide a service using the least amount of revenue.  She                     
 reiterated she agreed with Mr. Kohn's assessment, but she did not             
 want to close the issue off and because there was not an                      
 Number 1112                                                                   
 MR. KOHN responded Alaska had a growing senior population rate.  He           
 stated there were other ways to do this, and cited other states               
 were putting the elderly with ADRD into state mental institutions.            
 The other states did not have a pioneers' home to transform when              
 the problem came along.  Alaska was very fortunate to have the                
 facilities and history to address the problem head on.  He                    
 reiterated the home wanted to decrease its reliance on the general            
 Number 1239                                                                   
 CHAIR JAMES responded there was a need to expand, if the senior               
 population was increasing.                                                    
 Number 1248                                                                   
 MR. KOHN said for the time being the Pioneers' Homes would admit              
 people with increased acuity needs.  He reiterated in the future              
 the lower level ADRD cases would be taken care of in the community,           
 while the home would take care of those that exceeded the ability             
 of their families and the community.                                          
 Number 1294                                                                   
 REPRESENTATIVE GREEN wondered if the increased senior population              
 was a result of individuals moving to Alaska.  He further said he             
 did not see how the home would decrease its reliance on the general           
 fund when there was an increasing elderly population that could not           
 pay the rates.  He suggested looking at a completely different                
 program rather than patching-up the existing one.                             
 Number 1389                                                                   
 MR. KOHN responded the residents would pay all that they could pay            
 and create a debt to the state in-the-event they could not pay the            
 entire rate.  He further stated Alaskans were aging in place.                 
 Alaska was not a net migration in-state, but a net migration out-             
 state.  He said he did not agree with the idea of not extending               
 this to future residents.  He said the home would ask the current             
 and future residents to pay up-to-the cost of care.  He said some             
 residents would be able to pay the full cost, but only a handful.             
 He said the home had not done that in the past.  The bill,                    
 therefore, took away the anxiety of the resident from being                   
 evicted.  He stated, "I think we're going to reduce our reliance on           
 the general funds, not increase."                                             
 Number 1526                                                                   
 REPRESENTATIVE ROBINSON mentioned she was proud of the Pioneers'              
 Homes.  She stated she would support the Pioneers' Homes and                  
 believed in the direction of HB 384.  She said a state should honor           
 its seniors and hoped when she reached 80 years old a program such            
 as the Pioneers' Home was still available.  She further stated she            
 did not have a problem with the seniors returning to Alaska with              
 their families.  She stated Alaska was her home for the rest of her           
 life and wanted a place to bring her family.  She wondered what the           
 criteria was for families remaining together in the homes.                    
 The record reflected the arrival of Representative Ivan Ivan at               
 9:25 a.m.                                                                     
 Number 1660                                                                   
 MR. KOHN said it was common to see one spouse needing more care               
 than another, and a provision was made so that they could live                
 under the same roof.  He stated it made sense from a humane and               
 care point-of-view because the resident who needed ADRD care                  
 responded better to the spouse.                                               
 Number 1736                                                                   
 REPRESENTATIVE OGAN said the discussion was covering a lot of broad           
 based issues and drifting from an accomplishment.  He mentioned the           
 testimony from Ms. Janzen suggesting an asset shift.  He cited                
 children sold their homes to their parent for $100, for example, to           
 shift their assets to avoid taxes.  He suggested a conceptual                 
 amendment to provide provisions that addressed asset shifting.  He            
 stated he supported the concept and associated himself with the               
 comments made from Representatives Green and Porter that the state            
 needed to grandfather the current residents.  He stated his wife              
 worked for several years for the Pioneers' Home in Palmer and                 
 stated it was turning into a long-term care facility for dementia             
 residents.  He suggested, in general, the state needed to look at             
 taking care of those that could not support themselves for moral              
 and constitutional reasons.  He also said the state had enough                
 assets.  He commented if there were significant social reforms in             
 other areas, there would be more than enough money to take care of            
 those that could not.                                                         
 Number 1961                                                                   
 CHAIR JAMES said the Pioneers' Homes were intended for ambulatory             
 individuals who wanted a place to stay.  Now, the residents needed            
 intensive care of some kind when admitted.  She said, in concept,             
 she supported HB 384 and agreed with the grandfather approach.  She           
 stated there was a growing senior population due to improved health           
 care, and a younger population that could barely take care of their           
 own needs.  This was an overall family problem and families needed            
 to take better care of each other.  She stated a better way was               
 needed to take care the needs of the elderly in general and                   
 continue to look at providing services.                                       
 Number 2227                                                                   
 MR. KOHN said there was a lot of research being done on ADRD and              
 commented a treatment was possible, hopefully, in the future so a             
 home would not be needed for this type of care.  However, right now           
 care was needed, until such a treatment.                                      
 Number 2302                                                                   
 REPRESENTATIVE ED WILLIS said, "the longer we talk the more                   
 confused I get and if I get any more confused I'll be applying to             
 get into the Pioneers' Homes."  He commented at the present time              
 the home had not required anybody to leave for non-payment, and at            
 some point the home might have to ask somebody to leave.  "Is that            
 not correct, if I understand it correctly?" he asked.                         
 Number 2391                                                                   
 MR. KOHN replied the practice had been, if a resident was unable to           
 pay, the state subsidized the difference.  However, many of the               
 residents wanted the policy clarified as a result of the new rates.           
 The statutes addressed indigent residents and the conceptual                  
 framework was such that residents were not able to pay.  However,             
 it was not clear regarding the discharge of residents.                        
 Number 2460                                                                   
 CHAIR JAMES said HB 384 gave peace of mind to the residents of the            
 Pioneers' Homes and by putting it into statute it bound future                
 legislators.  She suggested accepting the committee substitute.               
 TAPE 96-17, SIDE A                                                            
 Number 0030                                                                   
 REPRESENTATIVE OGAN moved to adopt CSHB 384 9-LS1450/F.  Hearing no           
 objection, it was so adopted.                                                 
 Number 0053                                                                   
 REPRESENTATIVE PORTER said he was offended by a few things that               
 were intimated today, and cited, if he did not support HB 384,                
 seniors would be lined up in halls tied to wheelchairs and resented           
 that implication.  He said the intent of the Pioneers' Homes did              
 not anticipate the dementia rate.  He stated the Pioneers' Homes              
 responded to the needs, but to say that there was a commitment                
 because that was the intention, was totally incorrect.  He cited,             
 today the status of the Pioneers' Homes was a process of evolution.           
 However, he reiterated it was not the original intent.  House Bill            
 384 presented the bigger overall budget and fiscal gap of the state           
 by keeping as much as possible the programs and benefits provided             
 to the residents, or running the serious risk of not having another           
 Prudhoe Bay and close the Pioneers' Homes because the state could             
 not afford to operate it at all.  That was the discussion, he                 
 asserted, and not the desire to reduce benefits to seniors.                   
 Therefore, he stated he could not support the CSHB 384 in its                 
 current form.  He said he would support a grandfather provision for           
 the current residents, but had a problem binding future legislators           
 that might have to vote against seniors to the extend of                      
 jeopardizing the program.                                                     
 Number 0359                                                                   
 REPRESENTATIVE OGAN said he agreed with Representative Porter and             
 wanted to see the bill amended to include a grandfather provision.            
 He said the state owed the residents of the Pioneers' Homes that              
 peace of mind, and cited the seniors in his district were very,               
 very anxious and upset.  He suggested a conceptual amendment, for             
 example, to address disqualification based on asset shifting.  He             
 said it was a tough debate due to the timing surrounding an asset             
 shift, however.  He cited there were legal ramification if assets             
 were shifted surrounding an Internal Revenue Service (IRS) bill.              
 Number 0512                                                                   
 CHAIR JAMES stated the amendments needed to be in writing rather              
 than conceptually because they were major, and ruled against a                
 conceptual amendment                                                          
 Number 0539                                                                   
 REPRESENTATIVE WILLIS asked Chair James what was her intention of             
 HB 384.                                                                       
 CHAIR JAMES replied it was up to the House State Affairs Committee            
 REPRESENTATIVE WILLIS wondered where HB 384 went next.                        
 CHAIR JAMES replied it went to the floor.                                     
 Number 0561                                                                   
 REPRESENTATIVE ROKEBERG replied HB 384 was referred to the House              
 Health, Education and Social Services Committee (HESS), and the               
 House Finance Committee.  The zero fiscal note might influence the            
 Finance Committee referral, however.  The full review of the bill,            
 belonged in the HESS Committee, he asserted.  He said he preferred            
 to see the bill move to the next committee of referral, but he                
 understood the lack of comfort of some members of the House State             
 Affairs Committee.  He assured the committee members he would do              
 everything necessary in the interim to correct and meet some of the           
 issues addressed today.  He apologized to the Chair regarding his             
 apparent criticism of the methodology of the House State Affairs              
 Committee.  He entertained an amendment to address existing                   
 residents in-order-to move the bill forward.                                  
 Number 0654                                                                   
 CHAIR JAMES reiterated the responsibility of the House State                  
 Affairs Committee was to focus on the state as a whole.  Therefore,           
 the committee heard budget issues and at times the testimony                  
 appeared to move away from the issue, but it was necessary to look            
 at the bigger picture.                                                        
 REPRESENTATIVE ROKEBERG replied that he agreed.                               
 CHAIR JAMES continued by stating it was a different approach                  
 compared to other committees.                                                 
 Number 0725                                                                   
 REPRESENTATIVE OGAN suggested moving HB 384 to the next committee             
 of referral - the House Health, Education and Social Services                 
 Committee with individual recommendations to amend the bill.  He              
 stated the sponsor recognized the concerns of the House State                 
 Affairs Committee, and it was an issue that probably should be                
 debated in HESS.                                                              
 Number 0756                                                                   
 CHAIR JAMES said if the committee members really believed an                  
 amendment was needed it should be drafted in the House State                  
 Affairs Committee to not lose its voice.  However, HESS could                 
 remove the amendment which would be an appropriate action.  She               
 stated, if the sponsor would accept a conceptual amendment, the               
 bill could be redrafted before going to the HESS Committee.                   
 Number 0794                                                                   
 REPRESENTATIVE ROKEBERG said he would accept a conceptual amendment           
 as to the existing residents.  He stated he did not want to accept            
 the amendment Representative Ogan suggested due to existing                   
 provisions in statutes and it was not really the intent of the                
 bill.  He complimented Chair James on her analysis of the bill.               
 Number 0846                                                                   
 REPRESENTATIVE PORTER referred the committee members to page 1,               
 line 12, and read his suggested changes, "The department may not              
 evict a person from the Pioneers' Home whose residency began before           
 the effective date of this bill, if the income and assets...."  He            
 said he would leave it up to the drafter.                                     
 Number 0884                                                                   
 REPRESENTATIVE OGAN moved to adopt the conceptual amendment as                
 stated by Representative Porter.  Hearing no objection, it was so             
 CHAIR JAMES asked what was the will of the House State Affairs                
 Number 0940                                                                   
 REPRESENTATIVE ROBINSON moved CSHB 384(STA) from committee with               
 individual recommendations and a zero fiscal note.  Hearing no                
 objection, it was so moved from the House State Affairs Committee.            
 REPRESENTATIVE ROKEBERG thanked the Chair and the committee for               
 their time and effort.                                                        
 Number 0978                                                                   
 CHAIR JAMES asked the committee members to at a resolution related            
 to revised statute 2477.                                                      
 MR. WILCOX said he would provide the committee members with a copy            
 of the resolution.                                                            
 CHAIR JAMES asked the committee members to voice their concerns to            
 her regarding the resolution.                                                 
 Number 1051                                                                   
 CHAIR JAMES adjourned the House State Affairs Committee at 9:50               

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