HB 103-ASSISTED LIVING HOMES: HOUSE RULES  3:31:13 PM CHAIR KREISS-TOMKINS announced that the final order of business would be HOUSE BILL NO. 103, "An Act relating to house rules for assisted living homes." CHAIR KREISS-TOMKINS questioned whether HB 103 would affect operations for any subset of assisted living facilities and whether they would struggle to meet the standards that would be codified in the bill. 3:33:08 PM JOHN LEE, Director, Division of Senior and Disability Services, Department of Health and Social Services, reported that 650 of the 700 assisted living facilities that are licensed by the state are currently in compliance. He said he anticipates no significant challenges from non-compliant providers, as the required changes are minor. 3:33:53 PM CRAIG BAXTER, Assisted Living Home Manager, Division of Health Care Services, Department of Health and Social Services, shared his belief that the bill would not be burdensome for facilities that are not in current compliance with the required standards. He reiterated that approximately 650 of the 705 assisted living homes are already in compliance because they are state certified. He said he did not envision the remaining facilities struggling to implement the changes. CHAIR KREISS-TOMKINS asked why the remaining 50 facilities would choose not to be Medicaid certified. MR. LEE said the majority of providers in Alaska take Medicaid clients; however, some providers, for various reasons, focus on private pay or areas outside the provisions of Medicaid. MR. BAXTER noted that a handful are new providers that have not yet applied for certification. He surmised that some facilities choose to care for specific individuals who are private pay so there's no need for certification. Additionally, other facilities that meet licensing standards are unable to meet the standards for certification. He speculated that there is probably another small subset of [facilities] that had allowed their certification to lapse. 3:36:29 PM CHAIR KREISS-TOMKINS referenced page 1, lines 11-12, and asked for a description of the visitation rights provided under 42 C.F.R.441.301(c)(4)(vi)(D). MR. LEE relayed that 42 C.F.R states that if a facility chooses to set house rules, the rules must allow individual choice. More specifically, individuals must be allowed to have visitors of their own choosing at any time. Therefore, assisted living homes may not adopt house rules that restrict those rights. CHAIR KREISS-TOMKINS asked whether Mr. Lee had observed facilities in Alaska with unduly restrictive choice or individual access. MR. BAXTER said if the Division of Health Care Services became aware of that, the division would typically follow up with an investigation to determine the validity of the complaint. If the division determined the facility was out of compliance, it would be notified and required to show a plan of correction. he added that chronic offenders or a particularly egregious offense may require enforcement action. He shared that when Medicaid [facilities] implemented these specific visitation requirements, there were no issues aside for some pushback from facilities that expressed logistic concerns. 3:39:27 PM REPRESENTATIVE STORY asked how the quality care of residents is ensured in the 50 facilities that are not compliant. MR. BAXTER said [the Division of Health Care Services] conducts biannual inspections of most assisted living homes. If a facility is new or had its license reduced to a provisional license because of enforcement action, an annual inspection is conducted. He added that some facilities receive more frequent inspections due to their history of compliance. He reported that the division receives 8,000-10,000 critical (indisc.) reports annually, which are reviewed for compliance purposes to ensure that the facilities are responding appropriately to events and occurrences within their home. He approximated that 400 of those annual reports are upgraded to ensure that the facilities receive on-site investigation of compliance. Additionally, the division maintains routine contact with providers through a variety of training efforts. Groups that participate in on-site visits for that purpose typically communicate any concerns they may have about the facilities, which initiates follow-up inspections by the division to ensure compliance when necessary. 3:41:34 PM REPRESENTATIVE STORY asked whether the department had ever required the closure of a facility until the necessary changes were made. MR. BAXTER affirmed that every year, a handful of homes are closed by the department through an immediate revocation or suspension. Occasionally, settlement agreements or correction plans are entered into to allow the facilities to reopen; however, if a facility is closing because of its compliance history, it's typically beyond what the department considers a safe home for residents to reside in. He added that typically, it's abuse, neglect, financial exploitation, failure to require background checks, or failure to provide adequate fire safety. He explained that the department implements the policy of progressive enforcement action, so that by the time closure of the home or non-renewal of the license is required, it's justified. He reported that only 14 percent of the facilities statewide have had substantial complaints against them. He emphasized that the department's preference is for the facility to first, fix the problem as opposed to shutting its doors. He said closure is traumatic because it displaces residents and puts employees out of work; furthermore, in smaller communities, closing homes is often detrimental because alternative services are not available. REPRESENTATIVE STORY inquired about the compliance deadline. MR. LEE said the federal government's deadline is March of 2023. 3:45:01 PM The committee took a brief at-ease. 3:46:10 PM REPRESENTATIVE VANCE asked what kind of guidance is provided to assisted living homes that are not state-run facilities regarding [COVID-19] restrictions for residents. MR. LEE clarified that the bill is not related to the pandemic. Nonetheless, he noted that during the pandemic, the state disaster declaration and the federal government allowed the suspension of certain regulations. He further noted that the state produced visitation guidelines. REPRESENTATIVE VANCE asked if the bill were to pass, what would happen to the assisted living homes that failed to comply with the required changes. MR. BAXTER explained that if a facility were out of compliance, a finding against the facility would be assembled via a report of inspection or investigation. The home would then be notified and asked to make the necessary corrections. Additionally, should the bill pass, the department would require that the facility update its house rules to reflect the necessary changes. REPRESENTATIVE CLAMAN surmised that this matter pertains to the federal supremacy clause, such that the homes would lose their Medicaid funding if they failed to comply with the federal requirements. He said the state could set any rule they want, but if the federal government implements a rule that limits visitation, homes would be forced to follow that rule during the suspension of regulations. He asked if that is correct. MR. LEE asked Representative Claman to repeat his question. 3:52:07 PM REPRESENTATIVE CLAMAN asked whether an assisted living home receiving federal funds is required to follow federal rule. MR. LEE said Medicaid certified facilities are required to meet these statutes. REPRESENTATIVE CLAMAN interjected and clarified that he had asked about the COVID-19-related suspension of regulations. He sought verification that homes must follow federal rules during a suspension because otherwise, they would lose their federal funding. MR. LEE replied these rules were suspended during the federal public health emergency. REPRESENTATIVE CLAMAN sought confirmation that the federal government had provided visitation guidelines. MR. LEE replied in the affirmative. REPRESENTATIVE CLAMAN sought confirmation that homes receiving federal funds must follow the visitation guidelines set by the federal government. MR. LEE answered yes. He added that the state had issued guidelines to the facilities on how to operate safely during the pandemic. REPRESENTATIVE CLAMAN asked whether the facilities in Alaska are following direction from the federal government or the state on how to manage visitation during the public health emergency. MR. LEE said during the pandemic, the federal government allowed states to relax their rules; therefore, the facilities were following state guidelines. 3:54:47 PM The committee took a brief at-ease. 3:55:16 PM CHAIR KREISS-TOMKINS opened public testimony. After ascertaining that no one wished to testify, he closed public testimony. 3:55:44 PM REPRESENTATIVE CLAMAN moved to report HB 103 out of committee with individual recommendations and the accompanying fiscal notes. Without objection, HB 103 was moved from the House State Affairs Standing Committee.