HOUSE BILL NO. 58 "An Act relating to medical assistance for recipients of Medicaid waivers; establishing an adult care home license and procedures; providing for the transition of individuals from foster care to adult home care settings; and providing for an effective date." 1:35:16 PM Co-Chair Foster asked staff from the Department of Health (DOH) to review the fiscal notes. TONY NEWMAN, DIRECTOR, DIVISION OF SENIOR AND DISABILITIES SERVICES, DEPARTMENT OF HEALTH, thanked the committee for hearing the bill again. He briefly explained that the bill would provide elderly Alaskans and adults with disabilities enrolled in the Medicaid home and community based waivers with a new living option called adult home care. The bill established a new licensed residential setting type and a new certified service that would be overseen by DOH. He offered to take questions or provide an overview of the fiscal notes. Co-Chair Foster asked for a review of the fiscal notes. Mr. Newman reviewed the first fiscal note, OMB component number 2663, control code fpGii. The fiscal note primarily funded one position to begin in FY 25, which would implement and operationalize the adult home care service. The work would entail developing the organizational procedures around certifying and monitoring providers who offer the service, in addition to certifying and monitoring the providers. The position was new, and it would involve setting up the program, providing training, and making it clear to families and providers how the service was different from existing service options. The note included the salary of $119,100 for one health program manager II with $2,300 for some minimal travel, $14,000 for services (i.e., core service costs for an employee including IT, lease costs, HR, and fiscal management services costs), and $4,000 for commodities. The costs would be funded with 50 percent federal Medicaid funds and 50 percent state general Medicaid funds. 1:38:28 PM Mr. Newman reviewed the second fiscal note OMB component number 3234, control code boKBB. The note was zero and had been compiled by the department to demonstrate to the legislature that it had considered what it would cost to add a new service. The department had determined it would have a net zero impact on the Medicaid Services budget. He reminded the committee that the service was for people who were already eligible for Medicaid home and community based waiver services. He explained it would be a more expensive service in some cases and a less expensive service in other cases, leading to a net zero estimate. 1:39:32 PM RENEE GAYHART, DIRECTOR, DIVISION OF HEALTH CARE SERVICES, DEPARTMENT OF HEALTH, reviewed the last fiscal note, OMB component number 245, control code Pvlvr. The department was requesting one PCN [position control number] beginning in FY 25 for $105,000 with $10,000 in travel, $14,000 in services, and $1,000 in commodities. The department was looking at licensing approximately 40 new homes in the first year and the position would be responsible for regulations drafting, policies and procedures, training, and outreach to the new provider types. The department was requesting an additional PCN in FY 29 to reflect doubled cost. She explained there was an uptick any time a new license provider type came on board and the department assumed it would continue to see additional facilities wanting to be licensed under the program; therefore, the department was projecting 40 new homes in the first year and a similar amount in the outyears. The department would also have to do recertifications or relicensing in the fifth year. She explained the original licensed providers would be relicensed as new licenses were coming on board as well. She relayed that if the funding was approved, the department would be able to submit a path for the position in FY 29 and attach the approval of HB 58. The department would still have to go through the budget and the Office of Management and Budget (OMB) to get a PCN through classification. 1:41:55 PM Co-Chair Foster OPENED public testimony. MARGE STONEKING, ADVOCACY DIRECTOR, AARP ALASKA, ANCHORAGE (via teleconference), read from prepared remarks: AARP strongly supports continued expansion and improvement of home and community based waiver services to better serve our fast growing senior population, including offering a range of residential settings. The vast majority of us want to remain in our own homes and communities as we age and prefer a home setting over a nursing home or other institutional settings. Of course, as you know, home and community based services (HCBS) cost a fraction of what otherwise required nursing home care would cost. In the home care workforce crisis combined with our rapidly aging population, its threatening access to HCBS for private pay and state pay alike and that is already driving people into assisted living facilities. This could additionally drive elders into institutional care and because few can afford nursing home care, could ultimately increase the Medicaid rolls. That's why we need to use all tools in the toolbox to expand home and community based service options using proven service models from across the nation to offer choices to appeal to waiver participants and perspective workers alike. Adult home care is one such solution and AARP welcomes the administration proposing adult home care as an additional service option and adult care homes as a new residential setting for [inaudible] residents. It is our understanding that HB 58 will provide a pathway to creating a lower administrative burden for operators than group assisted living homes and the intent is to offer elders and others the option of more homelike settings with lower level services and fewer residents. For these reasons, AARP supports HB 58 and looks forward to working with the department on regulations required in the bill. We also urge the Department of Health, with the support of the legislature, to stand up additional initiatives that directly support the aging in place component of the governor's Healthy Families Initiative, including participant directed care. Aging in place is what the vast majority of older Alaskans want to do and home care services and support cost the state a fraction of what institutional care does. Co-Chair Foster noted that Representative Coulombe had joined the meeting. 1:45:52 PM ROBERT TASSO, HEALTH AND SOCIAL SERVICES PLANNER, GOVERNOR'S COUNCIL ON DISABILITIES AND SPECIAL EDUCATION, ANCHORAGE (via teleconference), spoke in support of the legislation and the companion bill SB 57. The legislation would expand home and community based services and establish a new residential setting category for adult home care. The bill would establish several main goals for stakeholders, particularly allowing legally responsible individuals including family members to care for seniors and individuals with disabilities and to receive financial support for the service. The bill would also allow for continuity of care for individuals to provide the necessary support for the family providing care and would lower cost and decrease the administrative burden normally required for an adult assisted living home. The bill provided an opportunity for enhanced support for caregivers of individuals with disabilities or individuals aging out of the foster care system. He highlighted the current workforce crisis and relayed that the bill would help address the issue that many providers had been struggling with. The governor's council supported the passage of the bill. Co-Chair Foster CLOSED public testimony. Representative Galvin asked if the fiscal notes included receipts for licenses. She wondered if it was not a part of the overall consideration. Ms. Gayhart replied that it would not be taken into consideration until DOH drafted the regulations. Currently the license fee was quite low at about $25 per bed. The department had not factored it into account because it did not yet know how many beds would come online. She explained it would be included in the outyears. She stated there would be limited receipts, but not to begin with. Representative Galvin wondered if it was common to have a placeholder in future years for accounting purposes. She suggested making note of the issue in the drafting. HB 58 was HEARD and HELD in committee for further consideration. Co-Chair Foster noted he intended to schedule the bill the following week. His staff would work with committee members regarding an amendment deadline.