Legislature(1999 - 2000)
02/23/2000 01:35 PM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
February 23, 2000
1:35 p.m.
MEMBERS PRESENT
Senator Mike Miller, Chairman
Senator Pete Kelly, Vice-Chairman
Senator Gary Wilken
Senator Kim Elton
MEMBERS ABSENT
Senator Drue Pearce
COMMITTEE CALENDAR
SENATE BILL NO. 256
"An Act relating to regulation of managed health care and allowing
physicians to collectively negotiate with a health care insurer
that has substantial market power."
-MOVED CSSB 256 (HES) OUT OF COMMITTEE
SENATE BILL NO. 228
"An Act relating to the financing of construction and major
maintenance of public school facilities; authorizing the
commissioner of revenue to sell the right to receive a portion of
the anticipated revenue from a certain tobacco litigation
settlement to the Alaska Housing Finance Corporation; authorizing
the issuance of bonds by the Alaska Housing Finance Corporation
with proceeds to finance public school construction and major
maintenance grants; providing for the creation of subsidiary
corporations of the Alaska Housing Finance Corporation for the
purpose of financing or facilitating the financing of public school
construction and major maintenance grants; relating to the annual
public school construction and major maintenance grant application
and approval process; providing for allocation of additional
reimbursement of public school construction debt; and providing for
an effective date."
-HEARD AND HELD
SENATE BILL NO. 224
"An Act relating to the confidentiality of investigations, court
hearings, and court and public agency information in child in need
of aid matters; relating to immunity regarding disclosure of
information in child in need of aid matters; amending Rules 3 and
22, Alaska Rules of Child in Need of Aid; and providing for an
effective date."
SCHEDULED BUT NOT HEARD
PREVIOUS SENATE COMMITTEE ACTION
SB 228 - No previous Senate action.
SB 256 - See HESS minutes dated 2/21/00.
WITNESS REGISTER
Jerry Reinwand
Blue Cross Blue Shield of Alaska
2 Marine Way, No.219
Juneau, AK 99801
POSITION STATEMENT: Commented on SB 256
Mr. Jeff Davis
Blue Cross Blue Shield of Alaska
2550 Denali St., Suite 600
Anchorage, AK
POSITION STATEMENT: Commented on SB 256
Mr. Jim Jordan, Executive Director
Alaska State Medical Association
4107 Laurel Street
Anchorage, AK 99508
POSITION STATEMENT: Supports SB 191
Mr. Mike Haugen, Executive Director
Alaska Physicians and Surgeons, Inc.
4120 Laurel Street, Suite 206
Anchorage, AK 99508
POSITION STATEMENT: Supports SB 256
Karen Rehfeld, Director
Education Support Services
Department of Education
801 W 10th St., Suite 200
Juneau, AK 99801-1894
POSITION STATEMENT: Presented and supports SB 228
Jim Baldwin
Assistant Attorney General
Department of Law
PO Box 110300
Juneau, AK 99811-0300
POSITION STATEMENT: Answered questions about SB 228
Ms. Pat Weaver
PO Box 877518
Wasilla, AK 99687
POSITION STATEMENT: Supports SB 228
Mr. Bob Dickens
Bering Straits School District
Box 225
Unalakleet, AK 99684-0000
POSITION STATEMENT: Supports SB 228
Marge Hays, Chair
Older Alaskans Commission
PO Box 2876
Soldotna, AK 99669
POSITION STATEMENT: Gave an update on the Older Alaskans
Commission
Jane Demmert, Executive Director
Older Alaskans Commission
Department of Administration
PO Box 110209
Juneau, AK 99811-0209
POSITION STATEMENT: Gave an update on the Older Alaskans
Commission
ACTION NARRATIVE
TAPE 00-7, SIDE A
Number 001
CHAIRMAN MILLER called the Senate Health, Education and Social
Services (HESS) Committee to order at 1:35 p.m. Present were
Senators Pete Kelly, Wilken, Elton and Miller. Chairman Miller
announced the committee would take testimony on bills until 2:30,
at which time the Older Alaskans Commission will give a
presentation. The first order of business to come before the
committee was SB 256.
SB 256-PHYSICIAN NEGOTIATIONS WITH HEALTH INSURE
SENATOR WILKEN moved to adopt the proposed committee substitute for
SB 256 (Version G) as the working document of the committee. There
being no objection, the motion carried.
JEFF DAVIS, Executive Director of Blue Cross Blue Shield of Alaska,
made the following comments. From Blue Cross's perspective, the
intent of SB 256 is to address inequities in bargaining power
between physicians and insurers - however, Blue Cross's experience
suggests that inequities are not the case in Alaska. Blue Cross
began talking with Alaskan physicians in 1989 about potential
agreements. Approximately 1,750 licensed physicians practice in
Alaska. After 11 years of work, Blue Cross has agreements with
approximately 700 physicians, which shows that Blue Cross does not
have extraordinary market power in Alaska. Aetna, the largest
insurer in the State, has made repeated attempts to negotiate
contracts with physicians and, according to an Aetna source, as of
yesterday Aetna has contracts with approximately 100 physicians.
Blue Cross understands that, amongst the other insurers in the
State, some may have a handful of contracts but most have none at
all.
MR. DAVIS repeated that Blue Cross does not have extraordinary
market power in Alaska because it has been unable to convince any
physicians in many specialties to join. He pointed out that Blue
Cross has made numerous attempts to make easier interactions
between physicians and Blue Cross members. Many physicians prefer
to collect full payment upfront from the patient. Physicians
agreed to bill Blue Cross directly and, in exchange, Blue Cross
agreed to pay physicians directly. Many members appreciate that
part of the agreement. Physicians also agreed to be credentialled
by Blue Cross. That process is done using national committee for
quality assurance criteria. The point of the credentialling
process is to give Blue Cross members additional confidence in the
physicians who are part of the network. Physicians also agreed to
cooperate with Blue Cross's care management program. That program
focuses on the appropriate setting of care for a particular member.
MR. DAVIS noted that physicians also agreed to refer members to
network providers, a point that was discussed by the committee at
a previous hearing. He provided verbatim language from a standard
Blue Cross contract which speaks only to hospitals and reads:
The provider agrees to arrange for admission of preferred
enrollees only to preferred hospitals provided that one is
available locally and, in the professional judgement of the
provider, admission to that preferred hospital will adequately
provide the enrollee's medical care needs.
MR. DAVIS said the decision as to where the patient's needs will
best be met is left to the physician.
MR. DAVIS stated the contracts also contain a 30 day termination
clause for the protection of both parties. If at any time a
physician says the agreement is not working, the physician can
terminate the agreement, and vice versa. In his five years of
experience, only one physician terminated because he did not want
to fill out the credentialling paperwork.
MR. DAVIS noted that Blue Cross is regulated by the Division of
Insurance with respect to how it determines usual, customary and
reasonable fees. Alaska statute requires Blue Cross to use Alaska
data, adjust the data by region, and review it every six months.
When Blue Cross looks at the data, it looks at each procedure code,
known as a CPT 4 code. All charges in the 12 month sample are
examined to determine, what physicians in Alaska have charged and
where the 90th percentile lies. The contract says that if the
physician's charge is less than the 90th percentile, then the
entire charge is covered. If the charge is above the 90th
percentile, the physician agrees to accept the 90th percentile and
the member will not be billed for the additional amount. The
contract results in members being protected from amounts over the
usual, customary and reasonable fee.
MR. DAVIS explained that Blue Cross identifies physicians who it
wants to have a discussion with in several ways: through member
requests, because of a gap identified in the network, or because
physicians contact Blue Cross. Blue Cross usually makes contact by
phone or in person. Blue Cross recently went through a push to
recruit. Since last October, Blue Cross has contacted about 140
physicians. Of those, 33 declined immediately, 91 requested more
information and are engaged in ongoing discussions with Blue Cross,
and 15 have reached agreements.
Regarding concerns raised about the federal employee program at the
last meeting, MR. DAVIS said of the 105,000 Blue Cross members,
35,000 are federal employees. The rules for the federal employee
program are set by the federal office of personnel management in
Baltimore.
SENATOR WILKEN asked if Blue Cross has a "hole" and has no contract
with a surgeon, how much Blue Cross reimburses.
MR. DAVIS said the terms of payment are dictated by the member's
contract with Blue Cross. The member's contract could say that
Blue Cross may pay 80 percent up to the allowable limit. The
difference is if there is a contract, the member is not responsible
for the amount over. If there is no contract, the balance is
between the member and the physician.
SENATOR ELTON asked if Bartlett Memorial Hospital is a preferred
hospital.
MR. DAVIS said it is.
JERRY REINWAND, a lobbyist for Blue Cross, commented that Blue
Cross has been unable to analyze what costs, if any, SB 191 will
have on subscribers. Blue Cross is concerned about the rise in the
medical consumer price index versus other consumer price indexes.
Any changes that have the potential to impact the price of health
care are of concern to Blue Cross. At Monday's meeting, a
testifier made the statement that physicians are having a very
difficult time with insurers, a statement which Blue Cross finds
befuddling.
MR. JIM JORDAN, Executive Director of the Alaska State Medical
Association, explained the amendments made in the proposed
committee substitute. First, the scope of the bill was increased
to go beyond insurance plans. That change was made through the
inclusion of intent language and by changing "health care insurer"
to "health benefit plan." Two other changes were made. Blue Cross
was concerned that only when negotiations involve fee related items
does the mechanism kick in whereby the criteria for the substantial
market share has to have been met by the insurer. Blue Cross is
concerned about how the number of folks covered will be determined.
That can take a great deal of work by a state agency. One of the
amendments provides for a rebuttable presumption so that when a
group of physicians, represented by an authorized third party,
requests of the Commissioner of the Department of Labor that the
process begin, the other party would be notified and given an
opportunity to rebut that presumption if it chooses to do so. The
last change adds a new section on page 10, AS 23.50.040, that
allows a health benefit plan to initiate the negotiation process by
making a request of the Commissioner when the health benefit plan
wishes to discuss fee related items with a group of physicians when
they do not have a substantial market share. This allows health
benefit plans to initiate the process and voluntarily ask the
commissioner to provide oversight and allow negotiations under the
state action doctrine exceptions.
SENATOR ELTON asked if physicians will be able to collectively
negotiate fees with the state about the state's self insurance
plan.
MR. JORDAN said it will and said he discussed that topic at length
with the drafter who created the mechanism.
SENATOR ELTON asked about the fiscal note.
CHAIRMAN MILLER pointed out the bill will be reviewed by the Senate
Finance Committee.
SENATOR ELTON asked whether the 30 percent requirement on page 8
pertains to the physicians in a particular specialty and whether it
only kicks in if the health benefit plan has more than five percent
of the local market.
MR. JORDAN said not quite. He indicated it means that an
authorized third party may not represent more than 30 percent,
however, an authorized party may represent more than 30 percent if
the health benefit plan has more than five percent of the market
share in a particular area. The reason that provision was included
is because of concern for rural areas where there may be very few
physicians.
SENATOR ELTON asked what the effect is of this provision on small
health care plans that do not have more than five percent of the
market share in a local community but where another health plan may
have more than five percent. He expressed concern that a small
insurer, who has less than five percent, may be driven out of the
market.
MR. JORDAN said that is why the bill was changed to allow for
voluntary participation. There are circumstances in which a small
insurer may not have that market share but can ask for oversight
under AS 23.50.040 (page 10, lines 8-10).
SENATOR ELTON said the bill essentially says a small health care
plan either conforms or disappears because the market threshhold
would be difficult for them to meet.
MR. JORDAN said that is correct but he does not see how they would
disappear because they would be allowed to voluntarily enter into
negotiations.
SENATOR WILKEN asked who authored the document entitled, "Response
to Comments by Gordon Evans" in committee members' packets.
MR. JORDAN said he wrote it.
MR. MIKE HAUGEN, representing Alaska Physicians and Surgeons,
stated that, in his opinion, Blue Cross is not the issue. The
issue is freedom of communication between doctors to discuss
patient protection and physician issues and managed care contracts.
Without the protections offered by this bill, physicians are
effectively gagged from discussing terms of contracts among
themselves, and not just the financial aspects. If the contracts
were about the financial aspects only, they would be one-half page
long. A typical contract is 15 to 20 pages. While it is true that
Blue Cross has negotiated term changes with some of the 700
contracts, many physicians have told him that because of Blue
Cross's large footprint in Alaska, they have to sign the contract
as is because they cannot afford to lose that much business. The
physicians in Fairbanks have incurred huge legal fees and had to
undergo one year of FTC scrutiny because of an anonymous complaint
phoned into the FTC. Under the current messenger model it is too
easy for a party with an axe to grind to notify the FTC and claim
that doctors are trying to boycott or price fix. SB 256 requires
state oversight to ensure that physicians are not boycotting or
price fixing. Again, the process is voluntary on everyone's part.
SENATOR PETE KELLY moved CSSB 256(HESS) with its accompanying
fiscal note to the next committee of referral.
SENATOR ELTON objected and said that intellectually, he does not
have a problem with people getting together and bargaining as a
group and that he will vote to move it on but he is very interested
to see what the Finance Committee finds.
SENATOR KELLY thought Senator Elton's concerns are valid and will
create a change, but he remarked the entire health care industry is
changing by quantum leaps. Alaska's doctors are quite isolated and
many of them are attached to a few health care plans, so they are
at a disadvantage to city doctors in other states. Other states
are choosing to go with this model as well.
CHAIRMAN MILLER agreed that both comments are valid and that the
legislature needs to know what all of the ramifications of the bill
will be. He noted that since less than 80 days are left in this
session, it is time to move the bill on so that some of the
questions can be answered by the Finance Committee.
CHAIRMAN MILLER announced that with no further objection, CSSB
256(HES) moved from committee.
SB 228-PUBLIC SCHOOL CONSTR/MAINTENANCE FUNDING
MS. KAREN REHFELD, Director of Education Support Services for the
Department of Education and Early Development, made the following
comments on behalf of Commissioner Cross. SB 228 provides a
funding mechanism for school construction and major maintenance
projects over the next three years. With over $1 billion
investment in school facilities in this state, Alaska cannot afford
to neglect major maintenance needs or replacement of schools. DOE
has consistently advocated for a long term stable source of funding
for school construction and maintenance projects. SB 228 will
address three goals. First, it will provide adequate, safe places
to learn by clearing up the backlog of major maintenance projects
statewide. Second, it will address the needs of both urban and
rural school districts with an emphasis on addressing major
maintenance projects quickly to avoid more costly construction
costs in the future. Third, it will address the concerns brought
forward in the Kasayulie lawsuit.
The package totals $510 million, including $360 million in grants
for school construction and major maintenance, and $150 million for
school debt reimbursement. The projects included in the Governor's
package are funded in the order in which they are ranked on the
department's priority list. As proposed, all 86 projects on the
current major maintenance list and 40 of the 69 new construction
projects will be funded. The current list would be frozen over the
next three years while these projects are underway.
MS. REHFELD continued. The rationale behind the legislation is
based on these goals, and sticking to the priority list and
completing as many projects as possible over the next three years.
Adjustments to the amount of funding for particular projects and
the final listing will need to be made as a result of appeal
decisions that are currently before a hearing officer as it relates
to the priority list. The State Board of Education will be meeting
in March to finalize the school construction and major maintenance
list. As the State continues to address the issues raised in the
Kasuylie case, there may be further modifications needed. Funding
for major maintenance and school construction projects is critical
in both rural and urban Alaska. SB 228 goes a long way toward
addressing those needs.
SENATOR ELTON asked if the State Board of Education will have the
opportunity to change the list before it is frozen when it meets in
March.
MS. REHFELD explained school districts may appeal DOE's annual
ranking decision as it was released in December. Those appeals are
then reviewed by a hearing officer. The hearing officer's decision
is taken to the State Board of Education who finalizes the list.
DOE plans to bring those changes back to the Legislature to
incorporate into SB 228.
SENATOR ELTON asked if the only anticipated changes to the list
will be those modifications made under the appeal process.
MS. REHFELD replied yes, any of the specifics of the funding of
those projects as they are resolved by the hearing officer.
SENATOR WILKEN recalled that at the December Bond Reimbursement
Committee meeting, the major construction list totalled $199
million, and the major maintenance list totalled $49 million. He
asked if that list was added to since December.
MS. REHFELD said she did not recall the date of the December Bond
Reimbursement and Grant Review Committee meeting, but DOE issued a
list on December 15 that would have changed somewhat based on
reconsideration of its November list. By statute, DOE is required
to release its initial priority ranking by November 5. School
districts then have the opportunity to ask for reconsideration. A
new list is published on December 15 and it is that list the school
districts would formally appeal.
SENATOR WILKEN thought the Bond Reimbursement Committee met on
December 9. He asked Ms. Rehfeld the total of the school
construction projects in SB 228.
MS. REHFELD replied the bill authorizes $360 million for all of the
projects on the major maintenance list and a portion of the new
construction list.
SENATOR WILKEN said he would check but he recalls a total of $250
million. He asked Ms. Rehfeld to discuss the source of funds for
the projects in SB 228.
JIM BALDWIN, Assistant Attorney General, explained the bill
contains two sources of funding for bonds that would be issued by
the Alaska Housing Finance Corporation (AHFC). The first would be
the authority of the State to sell the right to receive a stream of
revenue generated by the tobacco settlement. That amount is
expected to be $260 million. The additional $100 million would be
generated from the general obligation bond capacity of AHFC. The
total in the bill equals $369 million because additional amounts
are needed for reserve funds and things of that nature in order to
make the bonds marketable. This is within the agreement that was
entered into with the Legislature in 1998. Another piece of
legislation that will be tied to this will be the capital budget.
DOE expects the Legislature will then go forward and appropriate
for these particular projects in the capital budget. Securing the
tobacco settlement stream is a device that has been used in other
jurisdictions. It will be helpful to the State's position in the
Kasuylie case if a large amount of financing is devoted for rural
schools. This type of financing device allows for more of a
concentration on rural schools.
Another element of this bill provides for further authorization for
the bond reimbursement program - that part of the package totals
$150 million.
SENATOR WILKEN suggested the Kasuylie case is not a reason for the
Legislature to be considering this legislation. He asked if the
Administration is doing anything to change the system so that the
REAAs can help participate in the construction of their schools.
MS. REHFELD said there is no proposal at this point that provides
for a bond capacity or some other mechanism for REAAs to
participate.
SENATOR WILKEN asked if SB 228 contains a provision to develop a
prototype school or school program.
ASSISTANT ATTORNEY GENERAL BALDWIN said nothing in SB 228 expressly
provides for prototype schools but nothing prohibits them.
SENATOR WILKEN asked if DOE would object if such a provision was
added.
ASSISTANT ATTORNEY GENERAL BALDWIN said from the perspective of the
lawsuit, he does not know whether that might complicate things.
TAPE 00-8, SIDE B
MS. REHFELD replied that has been an issue that the Bond
Reimbursement and Grant Review Committee has been looking at and
she is not sure that it has actually come up with an approach that
captures all of the aspects of dealing with prototype schools.
CHAIRMAN MILLER indicated a number of schools on the project list
are within organized boroughs and asked if the amount included in
the bill is the state's approximately 70 percent share.
MS. REHFELD said if the Chairman is speaking specifically to the
grant projects that are included in the proposal, all school
districts have a required participating share.
CHAIRMAN MILLER asked if these projects are funded with 70 percent
by the State.
MS. REHFELD said yes, or whatever the participation level is.
SENATOR ELTON asked Assistant Attorney General Baldwin whether he
feels reasonably assured that this approach will satisfy the
plaintiffs.
ASSISTANT ATTORNEY GENERAL BALDWIN said he is comfortable that the
amount of $360 million to address the projects included in the bill
is highly likely to resolve the problems in the claims in the case,
whether it be by settlement or whether it be by making the case
moot. He said he respects Senator Wilken's view on the Kasuylie
case, and that view is shared by the Governor, but in the
discussions he has had with the plaintiffs, they are in general
agreement on the dollar amount and on the projects. There is an
ongoing discussion, however on how much will be spent on each
project.
SENATOR ELTON said he thought the amounts were settled and equalled
100 percent of the new construction and major maintenance.
MS. REHFELD said in the Governor's proposal, several of the
projects from the December 15 meeting that were initially
recommended to be phased are recommended to be fully funded. To
the extent that one would be able to go farther down the list if
the projects were phased or, conversely, try to fully construct as
many projects as possible, that would affect how far down the list
one can go. Because the proposal would freeze the list for three
years, DOE believes it is better to get as many projects completed
as possible during that three year period. Under this proposal,
there would be nine projects in year three that would be phased.
After the first year, those projects would receive additional
points toward ranking because the planning and design phase would
be complete. The goal is to try and complete as many projects as
possible.
MS. PAT WEAVER, a PTA member from Mat-Su, stated support for SB
228. She supports funding the statewide projects from tobacco
settlement money, and she believes students need clean, safe water.
She also supports debt reimbursement of 70 percent. SB 228 is a "no
frills" bill.
MR. BOB DICKENS, Bering Straits School District, commented that SB
228 is a long-awaited development in addressing the public school
construction in rural and urban Alaska. The biggest problem he has
seen over the last seven or eight years is that there has been no
consistency in the funding, especially in rural Alaska. SB 228 is
a big step in that direction. In the long run, it will give rural
residents the hope they have been looking for during the past seven
or eight years.
SENATOR WILKEN congratulated Mr. Dickens for keeping the school in
Golovin in first class shape. He pointed out that the Bering
Straits School District has three schools on the list. He asked if
that school district would be amenable to having three prototype
schools constructed in those three villages.
MR. DICKENS noted that five schools would be constructed in the
Bering Straits School District over a three year period: Golovin,
Elim, White Mountain, Koyuk, and Teller. Regarding prototype
schools, Bering Straits School District is more in favor of
standardization of equipment and mechanical systems because each
location has a unique terrain.
CHAIRMAN MILLER thanked all participants for testifying on SB 228
and noted his intent to take more testimony next Wednesday and to
pass the bill from committee at that time.
Number 870
MS. MARGE HAYES, Chair of the Older Alaskans Commission (OAC),
introduced other participants and Commission members: Alison
Elgee, Don Hoover, Doris Bacus, Jesse Gardner, Dan Karmun, Bill
Hermann, Ella Craig, Peggy Burgin, Kay Branch, and Bob Gregovich.
MS. HAYES said the Commission's focus is the continuum of care for
elderly Alaskans. Most seniors are remaining in Alaska instead of
leaving, plus most seniors are living longer, so the population is
growing. A lack of services for that population impacts seniors
and their family members as well. The least expensive way to go is
the home and community-based end of the continuum. At a Common
Ground Conference held in Anchorage recently, the goals expressed
by seniors are that they want to retain their independence,
dignity, and to stay connected to their communities.
As the continuum of care goes up, assisted living homes provide
more help. They cost more than the cost of remaining in one's
home, but are less expensive than living in a nursing home. She
noted that half of the people sitting in the committee room will
end up with Alzheimer's Disease if they live to the age of 85. The
OAC is trying to plan ahead and is collaborating as much as it can
with the other beneficiary groups of the Alaska Mental Health Trust
Authority (AMHTA).
MS. JANE DEMMERT, Executive Director of the OAC, reviewed the
materials contained in a packet provided to committee members:
OAC's current state plan, its last annual report and the agenda of
the current OAC meeting.
MS. DEMMERT gave a brief summary of information in the packet. The
chart on page 3 shows that the projected population of Alaskan
seniors in 25 years will be 125,000, a five-fold increase. A chart
on page 4 shows the estimated prevalence of Alaskans affected by
Alzheimer's Disease and Related Dementia. That population is
estimated to number more than 15,000 in 25 years. Prevalence
estimates also show that nationally, 10-15 percent of older people
experience alcohol misuse. The Division of Alcoholism suspects
that the rate of late-stage alcoholism is doubled in Alaska.
Medication misuse affects 1/3 of the senior population.
Unfortunately, negative interplay between the chemistry of
different medications can occur in people who take several
medications. Mental health issues also affect an estimated 15 to
25 percent of elderly Alaskans. Proper support and treatment can
ameliorate depression and other more severe mental illnesses.
MS. DEMMERT pointed out that critical needs can compound for older
Alaskans, especially when they are affected by factors such as
dementia, mental illness, substance abuse, and medical problems.
Intervening before difficult and challenging circumstances occur is
not only humane but cost effective. Page 8 shows what services are
available and where there are gaps in those services.
Older Alaskans, their families, and the OAC share the common goal
of easing or remedying complications before they become acute and
cause extraordinary stress to the individual and family. In so
doing, a personal and family crisis is avoided, as is dislocation
of a family elder and often extraordinary expense. Each week that
a person can stay in a lower cost assisted living facility instead
of a nursing home generates at the national level $100 to $600 per
week in savings. The savings in Alaska would be more pronounced
because the nursing home costs are higher. On a national level,
delaying nursing home placements for one month could result in a
savings of $1.12 billion per year.
MS. DEMMERT said that caregiving is emotionally and physically
demanding, although immensely rewarding. One of the supports that
OAC has in some areas of the state, through grants to the
Alzheimers Association and through senior centers, is counseling
and support groups for caregivers. The isolation that can occur
for the caregiver and the patient can be deadly. OAC is finding
that when an adult day service is available, the caregiver can be
employed elsewhere. That helps the family economically and gives
the caregiver social interaction, while the adult day care is
therapeutic for the patient. Of all of the different kinds of care
the Legislature invests in, 40 to 70 percent is paid for by grants
that come through the State. In addition, a tremendous amount of
the funding is being generated by local governments.
MS. DEMMERT pointed out that the Division of Senior Services
operates two Medicaid waivers for home and community based care.
Based on a close review of Medicaid waiver data collected in FY 98,
it is estimated that almost $25 milllion was saved by providing
home and community based care as opposed to nursing home care.
Adult daycare programs exist in 11 communities in Alaska.
Information and education services are in place in Anchorage,
Fairbanks and Juneau through the Alaska Alzheimers' Association.
Care coordination services are avilable in some communities and
regions to assess a person's social and medical needs, rather than
just the medical needs. Often a person could remain at home if
they can get help with something as simple as bathing, eating, or
getting up in the morning.
MS. DEMMERT informed committee members that worksessions were held
at the Common Ground Conference about what people hope to
experience during their later years. The hopes were simple, yet
profound. Seniors hope to remain in their homes and community, to
stay connected, to be safe, to be healthy, to maintain financial
self-sufficiency, maintain independence, and to live with dignity.
Seniors need a strategic continuum of care that integrates
nutrition, transportation, supportive services, housing, and home
and community-based care, including assisted living and nursing
homes.
MS. DEMMERT said legislators can make a difference by providing a
reasonable continuity of benefits. HB 161, which prorates
benefits, is truly unpredictable and could profoundly change the
possibilities of a person remaining self-sufficient. Second, cuts
to public services provided through municipal revenue sharing
impacts people who are vulnerable. Property tax exemption is one
of the tools that allows seniors to live independently. AHFC, in
relation to senior housing programs, is absolutely essential to
meeting housing needs. Last, SB 204 extends the sunset date for
the OAC.
SENATOR WILKEN clarified that John Hatchen is the Vice Chair of the
Long Term Care Task Force and that Representative John Coghill is
a member. He also informed Ms. Demmert that a group in Fairbanks,
named "Gaps in Care" is comprised of assisted living workers and
nurses who are trying to keep people in their homes and out of
institutions. He suggested that Ms. Demmert make contact with the
group.
There being no further business to come before the committee,
CHAIRMAN MILLER thanked participants and adjourned the meeting at
3:05 p.m.
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