HB 292-HOME AND COMMUNITY-BASED WAIVER SERVICES  3:35:38 PM CO-CHAIR SNYDER announced that the final order of business would be HOUSE BILL NO. 292, "An Act relating to home and community- based services; and providing for an effective date." CO-CHAIR SNYDER provided a quick recap of HB 292. She explained that the bill would help the state meet the growing need for home and community-based care within Alaska by addressing some of the challenges the Department of Health and Social Services (DHSS) is facing and aiding the department in providing these required services. She listed the three main components of the bill: increasing the threshold for reducing services, providing a pathway for restoring previously cut hours and services, and allowing family members to be compensated for providing care. She highlighted those available online to answer questions and proceeded to the consideration of amendments. 3:38:31 PM The committee took a brief at-ease. 3:38:37 PM CO-CHAIR SNYDER noted that Amendment 1 would not be offered. 3:39:05 PM CO-CHAIR SNYDER moved to adopt Amendment 2 to HB 292, labeled 32-LS1344\B.4, Foote, 3/19/22, which read: Page 1, line 14, through page 2, line 1: Delete ", reduce payment for services," Page 2, lines 23 - 31: Delete all material and insert: "(3) for purposes of a reduction in the  level of personal care and chore services under 42  U.S.C. 1396n(k) or Medicaid personal care services  under 42 U.S.C. 1396 - 1396p (Title XIX, Social  Security Act), the annual assessment must find that the recipient's condition has materially improved since the previous assessment; in [FOR PURPOSES OF] this paragraph, "materially improved" means that a recipient who has previously qualified for services is  able to function in a home setting with the reduced  level of services;  (4) for purposes of a termination of  payment for services, the annual assessment must find  that the recipient's condition has materially improved  since the previous assessment; in this paragraph,  "materially improved" means that a recipient who has  previously qualified for a service [A WAIVER] for" Page 3, line 8: Delete "and live independently" Delete "waiver" Insert "[WAIVER]" Page 3, line 13: Delete "and live independently" Delete "waiver" Insert "[WAIVER]" Page 3, line 15: Delete "(4)" Insert "(5)" Page 3, lines 25 - 27: Delete "a person who is qualified to provide  personal care services under the 1915(k) state plan  option under 42 U.S.C. 1396n or" Page 4, line 19: Delete "payment for services or" Page 4, line 23: Delete "a reduction in payment for services or" REPRESENTATIVE ZULKOSKY objected for the purpose of discussion. 3:39:12 PM CO-CHAIR SNYDER listed the changes proposed in the amendment, which reflected requests from the department and stakeholders. First, she explained that the amendment would remove language concerning payment for services that requires the department to do [time consuming] individual evaluations and does not align with the current structure for payment rate. She stated that a forthcoming amendment may give the committee the opportunity to address the rate setting process. She continued to the next change in Amendment 2 which would replace language around service level reductions to narrow the scope of the bill to only personal care services, as these were the services most used by stakeholders. She referred to conversations with the department that support the change as it would lessen the administrative cost associated with implementation. She moved on to the next component of the amendment which would remove the language "live independently" from the section of the bill describing the services to be provided by the state. She explained that while it is the intent of her office as the bill's sponsor to support Alaskans' access to services that allow them to live independently, she had received feedback from the department and other stakeholders that more research into assessment and the development of an inclusive definition of "living independently" would be prudent before including that language in statute. Last, she explained that the amendment would clarify language defining "independent healthcare providers" to remove the "certified" requirement, since registered nurses and APRNs are qualified to provide independent assessments. 3:44:02 PM REPRESENTATIVE ZULKOSKY removed her objection. There being no further objection, Amendment 2 was adopted. 3:44:21 PM REPRESENTATIVE SPOHNHOLZ moved to adopt Amendment 3 to HB 292, labeled 32-LS1344\B.5, Foote, 3/16/22, which read: Page 4, following line 15: Insert a new bill section to read:  "* Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to read: REPORT TO THE LEGISLATURE. Not later than one year after the effective date of secs. 1 - 4 this Act, the Department of Health and Social Services shall submit a report to the senate secretary and chief clerk of the house of representatives and notify the legislature that the report is available. The report must (1) include an assessment of the payment rates for home and community-based services in the state under a waiver or 1915(k) state plan option under 42 U.S.C. 1396n(k); the assessment must address the adequacy of those rates to ensure sufficient workforce needs for independent qualified health care professionals; and (2) assess and identify the adequacy of services under AS 47.07.045(a); this analysis shall include the number of individuals eligible for services, the number of individuals receiving services, the average length of time for which an individual is placed on a waitlist for services, and the average hours of service each recipient receives annually, monthly, and weekly; and (3) assess and recommend additional changes to state statute, regulations, and payment for services to enhance the delivery of services under AS 47.07.045(a) to individuals eligible to receive care, particularly changes involving decreasing waitlists, reducing services, and addressing workforce shortages." Renumber the following bill sections accordingly. Page 5, line 3: Delete "Section 5" Insert "Section 6" Page 5, line 12: Delete "sec. 6" Insert "sec. 7" Page 5, line 17: Delete "sec. 8" Insert "sec. 9" Page 5, line 18: Delete "Sections 5 and 7" Insert "Sections 6 and 8" CO-CHAIR SNYDER objected for the purpose of discussion. 3:44:26 PM REPRESENTATIVE SPOHNHOLZ explained that Amendment 3 would require the department to create a one-time report on the payment rates for home- and community-based services. She referred to testimony from the public that low wages for caregivers may be contributing to the lack of access to needed services. She stated that Alaska is facing a crisis in elderly care that will only get worse as the population ages, and the proposed report would provide the legislature with visibility into the issue and recommendations on how to improve service availability. CO-CHAIR SNYDER removed her objection. There being no further objection, Amendment 3 was adopted. 3:46:16 PM The committee took an at-ease from 3:46 p.m. to 3:56 p.m. 3:56:05 PM CO-CHAIR SNYDER asked Representative McCarty to confirm whether the adopted Amendment 2 accurately reflected the proposed changes in Amendments 4 and 6. She mentioned her understanding that Amendment 4 mirrored changes already occurring in Amendment 2, but that it included the removal of additional language about reducing service levels. 3:58:29 PM The committee took an at-ease from 3:58 p.m. to 4:03 p.m. 4:04:06 PM REPRESENTATIVE MCCARTY moved to adopt Amendment 4 to HB 292, labeled 32-LS1344\B.6, Foote, 3/17/22, which read: Page 1, line 14, through page 2, line 1: Delete ", reduce payment for services, or reduce  the level of services" Page 2, lines 23 - 31: Delete all material and insert: "(3) the annual assessment must find that the recipient's condition has materially improved since the previous assessment; for purposes of this paragraph, "materially improved" means that a recipient who has previously qualified for a waiver for" Page 4, lines 16 - 25: Delete all material. Renumber the following bill sections accordingly. Page 5, lines 1 - 3: Delete all material. Renumber the following bill sections accordingly. Page 5, line 12: Delete "sec. 6" Insert "sec. 5" Page 5, line 17: Delete "sec. 8" Insert "sec. 6" Page 5, line 18: Delete all material. CO-CHAIR SNYDER objected for the purpose of discussion. 4:04:11 PM REPRESENTATIVE MCCARTY confirmed that Amendment 2 addressed most of Amendment 4, aside from the removal of the language regarding reducing of the level of service. He shared that leaving this language in the bill may prohibit a reduction of service level if the "medical necessity" of the patient were to decrease or the patient were to request a service level reduction. He offered his understanding that removing the language would increase flexibility. CO-CHAIR SNYDER voiced her belief that protecting the ability to appeal a reduction of services was a key component of the bill and opined that the amendment would "gut" that component. She mentioned that another section of the amendment would prevent retroactive assistance for people who have had their services reduced in the recent past. She stated that she could not support the proposed amendment. REPRESENTATIVE MCCARTY reiterated his concern that by not removing the language about the level of service from the bill, those receiving care could not receive less service if their needs lessened. CO-CHAIR SNYDER maintained her objection. A roll call vote was taken. Representative McCarty voted in favor of Amendment 4 to HB 292. Representatives Snyder, Zulkosky, Sponholz, and Fields voted against it. Therefore, Amendment 4 failed by a vote of 1-4. 4:10:06 PM REPRESENTATIVE MCCARTY moved to adopt Amendment 5 to HB 292, labeled 32-LS1344\B.7, Foote, 3/17/22, which read: Page 2, lines 3 - 4: Delete "an annual" Insert "a biennial [AN ANNUAL]" Page 2, line 7: Delete "annual" Insert "biennial" Page 2, line 24: Delete "annual" Insert "biennial [ANNUAL]" Page 2, line 30: Delete "annual" Insert "biennial" CO-CHAIR SNYDER objected for the purpose of discussion. REPRESENTATIVE MCCARTY shared his understanding that to continue to qualify for care services though DHSS, recipients must provide an annual assessment through an independent practitioner. He referred to testimony that had revealed service recipients were struggling to find practitioners who could provide these assessments. He asked for a statement from DHSS about its reaction to the proposed amendment. 4:11:24 PM JOHN LEE, Director, Division of Senior and Disabilities Services, Department of Health and Social Services, introduced himself for the record. REPRESENTATIVE MCCARTY asked whether changing from an annual to a biennial assessment would be helpful for the department. MR. LEE explained that there was a classification of people who receive personal care services that require facility level treatment, and annual assessments for this population helps reduce the risk of institutionalization. Comparatively, he explained that people who are being served using Personal Care Attendants (PCAs) are at a lower risk for institutionalization, so rather than assessing all recipients annually, the department does an assessment on 10 percent of requests for renewal of services. A drastic change in a person's condition may also trigger an assessment, but he reported that there is no statutory requirement for DHSS to assess annually, and it would be a labor-intensive process to change from assessing 10 percent of recipients to testing all recipients biennially. REPRESENTATIVE MCCARTY withdrew Amendment 5. 4:14:19 PM REPRESENTATIVE MCCARTY moved to adopt Amendment 6 to HB 292 labeled, 32-LS1344\B.8, Foote, 3/17/22, which read: Page 2, line 26: Delete "and live independently" Page 3, line 8: Delete "and live independently" Page 3, line 13: Delete "and live independently" CO-CHAIR SNYDER objected for the purpose of discussion. REPRESENTATIVE MCCARTY explained that Amendment 6 would remove an occurrence of the "or live independently" language that Amendment 2 had missed. He confirmed that the rest of Amendment 6 was covered by Amendment 2. 4:15:15 PM The committee took a brief at-ease. 4:15:20 PM REPRESENTATIVE MCCARTY clarified that the necessary language was included in Amendment 2 and withdrew Amendment 6. [HB 292 was held over.]