HB 96-HOME CARE EMPLOYMENT STANDARDS ADV BOARD  4:33:17 PM CO-CHAIR FIELDS announced that the first order of business would be HOUSE BILL NO. 96, "An Act establishing the Home Care Employment Standards Advisory Board; relating to payment for personal care services; and providing for an effective date." [Before the committee was CSHB 96(HSS).] 4:33:35 PM REPRESENTATIVE MIKE PRAX, Alaska State Legislature, as prime sponsor, presented CSHB 96(HSS). He gave a prepared sponsor statement [included in the committee file] for CSHB 96(HSS), which read as follows [original punctuation provided]: Seniors are the fastest growing demographic in the state of Alaska and are living longer lives. The state's 85+ population is expected to increase by 500% between 2022 and 2050, of which, 1/3 will experience Alzheimer's and Related Dementia. The Alaska Department of Labor and Workforce Development predicts home care, a part of Alaska's continuum of care services for seniors and people with disabilities, to be one of the fastest growing and most in demand occupations in the state. Alaska faces an acute shortage of direct care workers, particularly outside of population centers. The potential provider workforce demographic, those age 18 to 64, is in decline. Furthermore, low pay and lack of benefits force many caregivers out of the profession and make recruitment and retention increasingly more difficult for agencies providing in-home care services. We need to create strong and long-lasting home care infrastructure in Alaska which will expand access to quality, affordable home and community-based care for seniors and people with disabilities, keep people in their homes and out of costly facilities, and bolster the creation of jobs. We also need to ensure that Medicaid funding for personal care services is wisely spent, with an adequate portion of the rate going to pay and benefits for direct care workers, in order to help address the workforce shortage. HB 96 accomplishes both of these objects by: • Establishing a Home Care Employment Standards Advisory Board that will investigate, advise, and develop recommendations on Medicaid rates and other policies to improve the wages, working conditions, and recruitment and retention of direct care workers. • Requiring that agencies providing personal care services spend at least 70 percent of the total annual funding they receive from the department for personal care services on the pay and benefits of Personal Care Assistants providing such services. REPRESENTATIVE PRAX provided a personal anecdote about his family's experience with home care providers with his aunt and uncle. 4:37:29 PM RILEY NYE, Staff, Representative Mike Prax, Alaska State Legislature, presented the sectional analysis [included in the committee file] on behalf of Representative Prax, prime sponsor of CSHB 96(HSS), which read as follows [original punctuation provided]: Section 1 amends AS 44.29 by adding new sections to it and various aspects of the Home Care Employment Standards Advisory Board. Thus, Sec. 44.29.900. Home Care Employment Standards  Advisory Board. This section is added to establish the advisory board on Home Care Employment Standards in Alaska. Sec. 44.29.905. Composition of the board. This section elaborates on the composition of the board which will consist of a chair, 6 voting, and 4 non-voting members. The section clarifies how many members should be sought from each represented group or institution. The members will be appointed by the Commissioner of Health after solicitation of applications. Thus, • Commissioner of Health or commissioner's designee (non-voting unless in the event of a tie) • Commissioner of Labor and workforce development (or the commissioner's designee) (non-voting) • Two members representing covered providers, (with variance in terms of size, services provided and geographical location) (voting) • Two members who represent direct care workers (voting) • One member who is an enrollee or representative of enrollees receiving covered services (voting) • One member who represents the office of rate receive (voting) • A representative of the Alaska Commission on Aging or another organization that represents seniors in the state (non-voting) • A representative of the Governor's Council on Disabilities and Special Education another organization that represents people with disabilities in the state (non-voting) Sec. 44.29.910. Term of office, vacancies, removal. This section explains how the members of the board appointed in AS 44.29.905(3) will serve and establishes how long they shall serve, options for reappointment and how vacancies will be filled. Sec. 44.29.915. Meetings. The section establishes the duty of the chair to call for meetings of the board with regularity and as needed. It also establishes that the board should meet at least three times each year and hold additional meetings as often as necessary to accomplish its duties. At every meeting, the Board will provide space for public testimony. Sec. 44.29.920. Quorum. The section clarifies that a majority of the members of the Board constitute a quorum in a meeting of the board for it to transact its official business and to approve any recommendations of the Board. Sec. 44.29.925. Compensation. This section refers to established rules under AS 39.20.180 to guide compensation of members of the board through per diem and expenses reimbursement. Other than that, members of the Board will not receive compensation. Sec. 44.29.930. Powers and duties. This section establishes the duties and powers of the board which include advising and consulting the department on medical assistance program payment rates for covered services and payment rate adequacy for covered services, as well as investigating employment issues and concerns including wages, working conditions and workforce development and making recommendations. This section also describes state compliance with information requests and testimony, and ensures the board will have access to data needed to fulfill its responsibilities. Sec. 44.29.935 Biennial report. The section requires the board to submit a written report biennially to the Commissioner. It also requires the department to take the recommendations of the board into consideration when setting rates for covered services. If the department sets a rate that differs significantly from the recommendation of the board, the commissioner shall provide written notification to the board and chair of each legislative committee having jurisdiction over Health and Social Services. Sec. 44.29.940. Publication of reports. This section mandates the publication of the reports on July 1 each year and the reports must be publicly accessible. The section also elaborates on what shall be included in the published reports. Sec. 44.29.945. Definitions. This section specifies the definitions of all the terms used in the sections above i.e. AS 44.29.900 - 44.29.945 including those that relate to Section 1915(c) of the Social Security Act (42 U.S.C. § 1396n(c)) Section 2 amends AS 47.07.045 by adding new subsections that require an agency providing personal care services to pay as compensation and benefits to employees providing personal care services at least 70 percent of total annual funding received by the agency for the purposes of providing personal care services, increasing to 80 percent by July 1, 2030, unless the agency receives a hardship exemption from the department. This section also requires the department to establish procedures and objective criteria for granting a hardship exemption, and sets alternative minimum requirements for an agency that qualifies for such an exemption. Section 3 amends the uncodified law of the State of Alaska by adding a new section establishing when the board should be appointed, that the first meeting should be held on or before October 1, 2025, and the issues to be investigated for the preliminary report which will be presented at the first meeting. Section 4 amends the uncodified law of the State of Alaska by adding a new section establishing the date for preliminary internet website publication of the publication to be no later than July 1, 2026. Section 5 amends the uncodified law of the State of Alaska by adding a new section instructing the Department of Health to amend the state plan under AS 47.07.045 and submit for approval to the United States Department of Health and Human Services, to the extent necessary. Section 6 amends the uncodified law of the State of Alaska by adding a new section that makes this Act conditional on the United States Department of Health and Human Services approving amendments submitted in accordance with section 5, or determines that approval is not necessary. Section 7 sets the day after the date on which the United States Department of Health and Human Services approves amendments to the state plan or determines that approval is not necessary under section 6 of this act, as the date section 2 of this Act takes effect. Section 8 sets July 1, 2025 as the date the Act takes effect, except as provided in section 7. 4:44:45 PM CO-CHAIR FIELDS suggested that increased support for home care would decrease the cost to Alaska with regards to nursing home care. REPRESENTATIVE PRAX responded that home care services are typically cheaper than care in nursing facilities or hospitals. 4:46:00 PM JUDY JESSEN, Senior Political & Advocacy Organizer, The Caregivers' Union SEIU 775, began her invited testimony by stating that SEIU 775 represents more than 55,000 direct care workers in Alaska, Montana, and Washington. She reported that Alaska is experiencing a demographic shift, noting that Alaska has had the fastest-growing senior population per capita in the country in the past decade. She further noted that this trend is expected to continue into the next decade and will create increased demand for care. She reported that older residents in Alaska and residents with disabilities are living longer lives, noting that needs become more complex with age. She also noted that Alzheimer's and elders dementia is "on the rise." She cited the Department of Labor & Workforce Development (DOLWD), predicting that "in-home care will be one of the fastest growing and in-demand occupations in the state." She further reported that the number of potential caregivers is in decline and stressed that the shortage was "even more stark" in rural and remote Alaska. She stated that the highest concentration of seniors lives in Southeast Alaska and the Peninsula. MS. JESSEN emphasized that institutional care and congregate care settings could cost the state hundreds of thousands of dollars per person per year. She cited a Department of Health (DOH) study, reporting that care provided in-house can cost 59 percent less than services received through intermediate care facilities for individuals with intellectual disabilities. She additionally reported that in-home care services can cost between 45- to 90-percent less that nursing home care for seniors and people with disabilities. She cautioned that the problem would only become more costly for Alaska without immediate change to support a strong, well-trained professional direct care workforce in Alaska. MS. JESSEN asserted that CSHB 96(HSS) would ensure that the state is maximizing the state's Medicaid personal care rate by creating a labor rate for personal care services which, she explained, was a percent of the Medicaid rate received by agencies for personal care assistant (PCA) services which is required to go into direct pay and benefits for direct care workers. She stated that Alaska's personal care services were provided through a non-traditional consumer-directed agency with choice model, meaning that less money was needed for overhead, as the agency held fewer responsibilities. She stated that the consumer, not the agency, was responsible for recruitment, hiring, training, et cetera. Additionally, she asserted that CSHB 96(HSS) would create transparency with regards to the distribution of the Medicaid personal care rate. She stated that the reporting requirements under CSHB 96(HSS) would help assess and change the efficacy of current personal care rates. She stated that the workforce standards advisory board, modelled after Delaware and created under CSHB 96(HSS) would help identify and plan long-term workforce needs and additionally assess whether the [personal care] rates are adequately meeting those needs. She stated that the proposed board, made up of various stakeholders, would identify priorities, recommend solutions, and assess resource needs for the caregiving industry. She said that demographic changes are underway, and caregiver shortages are deeply felt in Alaska. She concluded by asserting that CSHB 96(HSS) would be far less costly for Alaska in the long-term and provide Alaska residents with much- needed care. She thanked the committee. 4:53:10 PM REPRESENTATIVE COULOMBE asked whether there was a set hourly rate for PCAs. MS. JESSEN responded that "there are different service categories for which there are different rates." She explained that the hourly rate is set by DOH. She noted that the personal care services rate is one of the lower rates in Alaska. She further explained that CSHB 96(HSS) would allocate 70 percent of the personal care services rate, not 70 percent of the money received by agencies overall. 4:54:48 PM TONY NEWMAN, Deputy Director, Division of Senior & Disabilities Services, Department of Health (DOH), answered questions during the hearing on CSHB 96(HSS). He clarified that DOH establishes rates for personal care and pays $8.53 per 15-minute increment for PCAs. 4:55:35 PM REPRESENTATIVE SADDLER stated that the proposed advisory board in CSHB 96(HSS) appears to have a lot of authority and power, citing the powers and duties listed in the proposed legislation. He asked whether DOH was functioning adequately. REPRESENTATIVE PRAX deferred to Mr. Newman. MR. NEWMAN responded that the Center for Medicare and Medicaid Services (CMS) created a rule in 2024 called the Medicaid Ensuring Access Rule ("Access rule"), which requires the establishment of an "interested parties advisory group." He noted that the Access rule requires by law a variety of things to be implemented by the state over the next 8 to 10 years. He explained that the advisory board established under CSHB 96(HSS) would serve as the "interested parties advisory group" whose function was to assess rates of payment for personal care and other services. He said that Alaska was federally required by 2028 or 2030 to set an adequacy rule of 80 percent, meaning that 80 percent of Medicaid rate paid for personal care services would need to be given to the direct care worker. CO-CHAIR FIELDS stated that in 2020 or 2021, the legislature heard that there was a crisis in workforce availability, especially in homecare. He noted that a shift to nursing home care would be significantly more expensive for Alaska. He reported that Alaska attempted to ensure that there was adequate workforce availability for homecare and that it became unclear whether the workforce was being adequately paid. He asserted that CSHB 96(HSS) was necessary to collect data on pay. REPRESENTATIVE SADDLER asked whether the powers and tools of the proposed advisory board were necessary to fulfill the requests of CMS. He referred to the proposed board as "nuclear-powered." 4:59:21 PM REPRESENTATIVE COULOMBE thanked Representative Prax for CSHB 96(HSS), noting that she had heard through public testimony in prior years that caregivers were overworked and underpaid, and that there was little oversight. CO-CHAIR FIELDS offered his agreement with Representative Coulombe, opining that CSHB 96(HSS) was very important in both providing adequate care and containing long-term Medicaid spending. [CSHB 96(HSS) was held over.]