HOUSE BILL NO. 73 "An Act relating to complex care residential homes; and providing for an effective date." 2:10:32 PM Co-Chair Foster asked his staff and the department to come to the table. Co-Chair Schrage MOVED to ADOPT the proposed committee substitute (CS) for HB 73, Work Draft 34-GH1493\N (A. Radford, 5/8/25) (copy on file). Co-Chair Foster OBJECTED for discussion. Co-Chair Foster asked his staff to explain the CS. BRODIE ANDERSON, STAFF, REPRESENTATIVE NEAL FOSTER, explained the changes in the CS located on page 3. He began on line 10 with the language: "provides 24-hour multidisciplinary care on a continuing basis to individuals with..." He explained that the previous version included a 15-bed limit associated with the language. The CS did not include the 15-bed limit. He moved to page 3, line 19 and explained that Section 6 of the bill read "this act takes effect July 1, 2026." He noted it reflected a change to the bill's effective date. He detailed that all of the conditional language had been deleted. He relayed that the Department of Health (DOH) would explain the reason for the accompanying memo from Legislative Legal Services (copy on file) in regard to the conditional language and effective date and would explain why it was not a concern to the department. 2:13:25 PM EMILY RICCI, DEPUTY DIRECTOR, DEPARTMENT OF HEALTH, explained that the bill created a licensure type that could exist independent of any certification from the Centers for Medicare and Medicaid Services (CMS). Section 5 of the CS provided DOH with the ability to apply for waivers as necessary to meet the needs of individuals in complex care residential homes. She expounded that for CMS to approve coverage for services in a home, it required that the home or residential facility or unit be certified. The certification was separate from the license type. She detailed that in the past, the department had put forward bills that include the conditional language, but it was not necessary for the actual license type to take effect. The department was focused on getting the service in place for populations in need. The department believed a clean effective date would allow it to move forward expeditiously and would not impact the result of the bill. She explained that Section 5 still gave DOH the flexibility to align Medicaid payments for individuals receiving services in complex care residential homes. Representative Galvin assumed DOH needed to go through the process to get the waiver. She wondered if Ms. Ricci thought that it may not be necessary. Ms. Ricci replied that depending on the type of individual and the care they needed, different funding mechanisms may be available through the Medicaid program. The department may be able to provide some of the services through existing payment means for individuals in complex care residential homes within some of the available waiver or state plan services. Whereas, for other types of individuals (e.g., individuals with dementia and severe mental illness), the department may need to look at a different type of waiver in order to have Medicaid support the services. She noted that the state may be able to amend the existing 1115 waiver for some populations. She remarked that it could get a bit complicated, which was the reason DOH wanted to ensure there was flexibility on the implementation date for the licensure type. Representative Galvin asked if DOH was working toward completing the licensure type by the date specified in the bill or if DOH would begin working on the licensure type on the specific date. Ms. Ricci answered that DOH would be prepared to have the licensure type ready by the date specified in the bill. The department would be working through the regulatory process to outline what the licensure type would look like for some of the populations. Simultaneously, DOH would be working with the Medicaid program to determine funding streams that would be available for some of the different populations. 2:16:52 PM Representative Bynum observed that changing the effective date to July 1, 2026 would mean waiting until 2026 for the bill to go into effect. He asked for verification that it would give the department the time to prepare for the rollout on July 1. Ms. Ricci agreed. She explained it was one reason the department wanted to remove some of the conditional language to make sure it was possible to move quickly. She elaborated that the department believed having the effective date in hand for the licensure type gave the department the ability to do so. Representative Bynum asked if the changes in the bill would result in any changes to the fiscal notes. Ms. Ricci answered, "No." Co-Chair Foster WITHDREW the OBJECTION. There being NO OBJECTION, Work Draft 34-GH1493\N was ADOPTED. 2:18:15 PM Co-Chair Schrage MOVED to REPORT CSHB 73(FIN) out of committee with individual recommendations and the accompanying fiscal notes. There being NO OBJECTION, it was so ordered. CSHB 73(FIN) was REPORTED out of committee with nine "do pass" recommendations, one "no recommendation" recommendation, and one "amend" recommendation and with one new indeterminate fiscal note from the Department of Family and Community Services; two previously published fiscal impact notes: FN1 (DOH) and FN2 (DOH); and one previously published zero note: FN3 (DOH). Co-Chair Foster thanked the department.