HB 464 - NURSING CARE AT STATE VETERANS' HOME Number 1945 CHAIR MASEK announced the last order of business would be HB 464 "An Act relating to state veterans' home facilities," sponsored by the House State Affairs Committee. BARBARA COTTING, Legislative Assistant to Representative Jeannette James, Alaska State Legislature, came before the committee to explain the legislation. She informed the committee members that several weeks ago Veterans Organizations visited her office and presented some of their legislative priorities and HB 464 is a result of her conversation. Ms. Cotting read the following statement into the record: "House Bill 464 amends Chapter 98, Session Laws of Alaska 1992. This special law of Alaska authorizes an Alaskan veterans' home and includes verbiage identifying domiciliary care. However, in order for the state to recuperate approximately 65 percent of the construction costs of the home from the Veteran's Administration, the law must include nursing facilities. Without them, the state will have to shoulder the burden of all construction costs. "Further, veterans' homes in other states are self sufficient in many cases because they contain nursing facilities. The nursing facility allows the state to collect medical fees from Medicare, Medicaid, and other third party health insurance. This offsets any state operating costs." MS. COTTING noted that many of the veterans are out-of-state at another meeting, so they couldn't be in attendance to testify on the bill. She noted that she is not an expert on the details of the legislation. Number 2021 REPRESENTATIVE JOULE indicated there is a huge fiscal note. CHAIR MASEK stated that she assumes the bill will pick up another committee of referral. REPRESENTATIVE JOULE referred to medical care for veterans and asked if there is currently an arrangement with the hospitals around the state where the veterans can get their medical conditions taken care of. MS. COTTING explained she does not know the answer to the question, but would defer to anyone who does. Number 2062 REPRESENTATIVE RYAN stated, "A facility would establish a Medicaid number with the Medicaid portion of our health, education and social service. And they would submit a claim of code - proper authorized codes, and then they would argue whether they're going to get paid. Not all payments are as speedy - as expedited as they should, but eventually they sort things out and the payment comes considering the service provided, what particular service it was and what the eligibility of the recipient was. It is pretty much straight forward. They're the same as the hospital or anybody else would bill. I'll give you a small conflict on this, my wife is a registered nurse and works in nursing facilities. In case anybody - there's a conflict there I'm declaring. It's generally similar to a nursing home, long-term care facility if you have the nursing services available. People who have to have medical procedures or nursing care would come under regular insurance and/or whatever their eligibility would be. The Veteran's Administration (VA) -- adds a coverage for these people they would be reimbursed through, however that was with the VA." Number 2118 REPRESENTATIVE JOULE said there is nursing care facility for the elderly in Kotzebue. He said if a new veterans' facility was constructed, would those people in Kotzebue have to the use the new facility first, wherever it was located rather than the one in their home community. REPRESENTATIVE RYAN said his knowledge of the actual veterans' care facility is some years dated, but the last time he was aware, since they did not have a veterans' facility in the state, most facilities that offered medical care were eligible to provide care to veterans and be reimbursed by the VA. He referred to a military hospital (indisc.) in Fort Wainwright and said he is not sure if the one at Elmendorf provides the same thing, but he knows that private medical facilities also had that ability because evidently the federal government didn't want to incur the cost putting a facility in Alaska. It is just a lot easier to use the existing facilities and to pay for the care. Number 2183 JAMES L. KOHN, Director, Division of Alaska Longevity Programs, Department of Administration, came before the committee. He noted he is the author of the fiscal note. He explained the information that Representative Ryan discussed is correct. Mr. Kohn read the following paragraph out of letter from Senator Murkowski with regard to the possible construction of a VA home in the state of Alaska: "We should also realize that we have VA community nursing home program now. It obligates the federal government to pay the total cost of care of veterans that the VA places in community nursing homes. We need to realize that after the home is opened, if the home was established, we will be exchanging some of that federal money for state obligations and it will not be on a one to one trade, in fact it's nowhere near a one to one trade." MR. KOHN said if a veteran has a long-term care need and is eligible, they're able to enter their community program, the Veteran's [Administration] are at this time obligated to pay those total costs. If you build a veterans' home in North Pole and you live in Ketchikan, you'll have to go to North Pole to get that kind of care. Number 2263 REPRESENTATIVE JOULE indicated he knows some of the veterans who are at the senior facilities. He said, "They want to be close to home because they're in their -- you know, that's about as close as they can get, if they're from the villages, to their family. And they're not going to be around much longer and to be totally some place else -- I know this sounds kind of cruel, but to die alone is a lonely thing. In terms of -- they're getting care currently under this current system. This is not broken. What are we doing?" MS. COTTING said the bill was introduced as a direct response to a response by the Veteran's Association. She said since they are not in attendance to present their rationale, she can't speak for them. She noted that she believes there is a compromise that is currently being worked on. She said pointed out that the next committee of referral is the House State Affairs Committee that Representative James chairs. Ms. Cotting stated, "If it's possible to move this out and then anybody who has watched State Affairs the last few years knows it will get a thorough hearing in there. It won't get rushed through. I think the sponsor of the bill, Representative James, would give it a good hearing in State Affairs. If the committee would care to move it on out since we don't know when you'll be meeting again, that might be an option. Granted, the bill is flawed as it is and there needs to be a lot more work on it." She said Representative Joule's point is true in that it would be terrible to take people away from their homes in their last years. Number 2344 REPRESENTATIVE RYAN stated he agrees with Representative Joule. He said we have a unique situation in Alaska and they don't do this anywhere else. He discussed the hardship of uprooting people that would have to move to the home. Number 2379 REPRESENTATIVE MULDER said he believes that there are quite a few good reasons for considering the bill. He said, "I probably would advocate that we just turn a blind eye at this point in time towards the fiscal note because certainly the $10 oil, most things with fiscal notes has pretty though scrutiny up in Finance right now. But look just at the merits of the issue and I think that we've raised some concerns today, but I think there are also some merits to it in terms of the focus and attention that are placed on veterans by VA homes and domiciliary. So with that, Madam Chairman, I would move that we pass [HB] 464 along to State Affairs, knowing it will pick up a Finance referral as well, and along with its accompanying fiscal notes and individual recommendations." CHAIR MASEK asked if there was an objection. Hearing none, HB 464 was moved out of the House Special Committee on Military and Veterans' Affairs.