HOUSE BILL NO. 528 6 "An Act relating to applications for certificates of need and licensing of nursing homes; amending the standard of review for certificates of need for health care facilities in the state; establishing a moratorium with respect to new applications by prohibiting the issuance of a certificate of need or a license for additional nursing home capacity in the state until July 1, 1998; and providing for an effective date." HARLAN KNUDSON, EXECUTIVE DIRECTOR, ALASKA HOSPITAL AND NURSING HOME ASSOCIATION testified on HB 528. He provided members with recommendations for modifications to HB 528 (Attachment 1). He maintained that HB 528 is an opportunity to create a plan to meet Alaska's long term care needs. Mr. Knudson reviewed Attachment 1. He requested that in section 1, subsections (1) and (2) be deleted. He observed that there were 764 licensed nursing home beds in January 1992. He stressed that the State pays by the bed. The occupancy of nursing home beds was 84 percent in January 1992. Medicaid accounted for 70 percent of occupancy. He pointed out that the pioneer home in Ketchikan contributes to the low occupancy rates. There was 758 beds in January 1, 1996. He disagreed that there is an overabundance of nursing home beds. He noted that occupancy of nursing home beds in Anchorage and Fairbanks is above 90 percent. He maintained that the moratorium requires rural residents to send their elderly to urban areas. He stressed the cultural difference between rural and urban areas. Mr. Knudson requested that section 2 be deleted. He maintained that section 2 takes responsibility from the legislature. Section 2 allows the Department of Health & Social Services to establish state policy on the funding of new construction or new services for health facilities in Alaska. He asserted that the Department can deny nursing home beds to protect its Medicaid budget. Representative Martin maintained that the executive branch has the responsibility for establishing policy for many state programs. Representative Kelly pointed out that the executive branch establishes regulations based on the statutes. He maintained that the legislature establishes policy. Mr. Knudson stated that providers and state agencies have the responsibility to identify the needs and recommend policy to the legislature and implement the policy directives of the legislature. He emphasized that agencies should not establish were funding should be provided and overall policy. 7 Mr. Knudson noted that the Alaska Hospital and Nursing Home Associations supports a one year moratorium on nursing home beds. He emphasized that this is the second year of a three year moratorium. He pointed out that a study on the long term care needs of Alaska was contracted by the Division of Senior Services in June 1995. He stressed that the study will be released soon. He stated that if the next Legislature does not agree with the recommendations of the study the moratorium could be extended. Mr. Knudson recommended that section 4 be amended to include a nursing home administrator and that "working group" be changed to "planning group". He stated that the planning group should propose a plan identifying needs, priorities and funding sources. Representative Mulder noted that proposed committee substitute, Work Draft 9-LS1731\F, dated 4/11/96 reflects Mr. Knudson's request for deletion of section 1 (1) and (2) (copy on file). He added that the work draft provides a one year moratorium. HB 528 was HELD in Committee for further consideration.