SENATE BILL NO. 98 "An Act relating to medical assistance for recipients of adult foster care services; establishing an adult foster care home license and procedures; and providing for the transition of individuals from foster care to adult foster care homes." 9:25:04 AM Co-Chair Bishop relayed that it was the first hearing of SB 98 during the current session. The committee had heard the bill and had opened and closed public testimony on April 7, 2021. The committees attention was to consider a proposed CS, hear a bill reintroduction, and then set the bill aside. Co-Chair Stedman MOVED to ADOPT proposed committee substitute for SB 98, Work Draft 32-GS1708\G (Foote, 4/2/22). Co-Chair Bishop OBJECTED for discussion. Ms. Shine addressed explained that the proposed CS took a slightly different approach than Version A of the bill that came to committee. The CS removed adult foster home and added adult home care, which would extend opportunities for participation beyond individuals aging out of foster care to include other adults with disabilities. The change would also add a new service and a license placement type of adult home care for adults with disabilities and seniors. The CS also proposed to change the Department of Health and Social Services to the Department of Health in applicable areas because of Executive Order 121 [an order passed by the governor in 2022 that would divide the Department of Health and Social Services into two departments aligned by functionality]. The CS proposed an effective date of July 1, 2022, to coincide with the effective date of the executive order. Co-Chair Bishop WITHDREW his OBJECTION. There being NO further OBJECTION, it was so ordered. The CS for SB 98 was ADOPTED. 9:26:53 AM AT EASE 9:27:01 AM RECONVENED JOHN LEE, DIRECTOR, SENIOR AND DISABILITY SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via teleconference), spoke in support of the bill. He thanked the committee for hearing the bill. He thanked Co-Chair Bishop's office for working to amend the bill in ways that he thought would strengthen home and community-based services. He discussed working towards increasing the reach of the bill to more individuals with disabilities. He discussed working with stakeholders on the concept of expanding the bill to include others and create more options to remain in home and community-based settings. Mr. Lee continued his testimony. He suggested that changes would make services less expensive, have a less demanding workforce expectation, and would be open to more providers. He noted that there was work to be done on regulation and he was confident that the bill would create a setting to serve the population as well as allow for many seniors to stay in local communities. He summarized that the change would create a small economic opportunity in rural areas. He noted that the new adult home care services would be less expensive than some services, but more expensive than others. He emphasized that aside from new additional staff needed to monitor the new service, the amendments to the bill were cost neutral. Research conducted by the department had shown that savings from the bill would offset additional costs. 9:31:30 AM ANTHONY NEWMAN, DEPUTY DIRECTOR, SENIOR AND DISABILITY SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via teleconference), addressed a Sectional Analysis (copy on file): Section 1: Adds a new section to AS 47.07, Medicaid Assistance for Needy Persons, to create a new program- adult home care services for individuals. Adult home care services will be available for individuals at least 18 years of age or older who are enrolled in a home and community-based waiver. The Department of Health will develop regulations establishing the standards and rates of the program and providing an efficient process to allow existing foster homes to transition into the new adult home care license. Section 2: Amends AS 47.32.010(b) to add a new setting, "adult home care homes," that shall be subject to the centralized licensing functions of the Department of Health. Section 3: Adds a new section to AS 47.32 that defines the conditions under which the department may license an adult home care home. A person may be licensed to operate such a home for up to two persons aged 18 or older who are enrolled in home and community-based waiver services. This section requires the department to streamline the application process necessary for the person to be approved as an adult home care home provider and requires that the department approve variances of building code requirements to the extent permitted by state, local, or federal law. Section 4: Amends uncodified law by adding a new section that requires the Department of Health to submit for approval by the United States Department of Health and Human Services an amendment to the state medical assistance plan, waivers, or an 1115 demonstration waiver as necessary to allow eligible individuals to receive adult come care services and other long-term care services that are not duplicative. Section 5: Amends uncodified law adding a new section related to the conditional effect of section 4 and the required state plan amendments submitted to the United States Department of Health and Social Services. Requires the department to notify the revisor of statutes of the approval of state plan amendments. Section 6: Effective date related to the requirement for the department to provide notification of the revisor of statutes of approval of state plan amendments. Section 7: Provides for a July 1, 2022 effective date to align with the effective date of Executive Order 121 and the change of the applicable department to the Department of Health. 9:34:24 AM LIZETTE STIEHR, EXECUTIVE DIRECTOR, ALASKA ASSOCIATION FOR DEVELOPMENTAL DISABILITIES, CHUGIAK (via teleconference), spoke in support of the bill. She expressed gratitude for the committee's inquiry about expanding the bill to serve more people. She described that her organization had asked the same question. She explained that currently group homes that were allowed to provide services must meet the same licensing that applied to group and assisted living homes. She strongly supported a shared vision that believed in a flexible system that supported individuals toward having meaningful lives and choice. She thought the bill would expand living options for people that experienced developmental disabilities. She loved the fact that the bill would allow foster children to remain in the same home. 9:36:20 AM MICHELE GIRAULT, BOARD RESIDENT OF KEY COALITION AND EXECUTIVE DIRECTOR, HOPE COMMUNITY RESOURCES, ANCHORAGE (via teleconference), testified in support of the bill. She thought the bill aligned with the shared vision mentioned by Ms. Stiehr and provided greater flexibility for those providing services to youth with disabilities. She discussed current statute and the administrative burden it caused. She explained that the bill would simplify the process of allowing a family to transition from a child license to an adult home care license with the likely outcome of youth being able to stay in the same home. She thought the bill would allow for youth to have continuity of care. Ms. Girault continued her testimony. She noted that youth with disabilities had options to stay in the public school system until the age of 20. She urged the committee to support the bill. She thought the expanded outreach of the bill to support additional adults would also provide benefits. Senator Wielechowski understood that the statute for long- term care only included authority for homes for people over 60 and asked if the bill should amend the statute to include the homes. Mr. Lee did not think the change Senator Wielechowski described needed to be made. He asked for additional testifiers to weigh in on the matter. Co-Chair Bishop asked if department staff could address the question. 9:40:17 AM CRAIG BAXTER, PROGRAM MANAGER, RESIDENTIAL LICENSING, DIVISION OF BEHAVIORAL HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via teleconference), addressed Senator Wielechowski's question. He did not believe the statute needed to be amended. He thought it might be beneficial to reach out to someone that dealt with long-term care. Co-Chair Bishop suggested that Mr. Lee provide a written response to Senator Wielechowski's before the bill was heard in committee again. Mr. Lee agreed to provide the information. Co-Chair Stedman considered the fiscal notes and observed that there was an increase in Medicaid services of $168,000 per year. He was curious as to how the department would cap the amount so that it did not continue to escalate. He mentioned the slight decrease in state population. He acknowledged problems controlling costs in health and social services in the state over the last decade. Mr. Baxter thought Co-Chair Stedman might be looking at an old fiscal note as the current fiscal note did not project any cost increases to Medicaid services. 9:42:28 AM AT EASE 9:42:47 AM RECONVENED Co-Chair Bishop asked if Mr. Lee anticipated forthcoming updated fiscal notes for the proposed CS. Mr. Lee answered in the affirmative. Co-Chair Stedman observed that the fiscal notes in front of him were dated from March of the previous year. He wanted to see updated fiscal notes and expressed concerned about the growth of the department. He mentioned the budget for the Department of Corrections as an area of concern. Senator von Imhof thought the bill represented an age-old conundrum, particularly with legislation related to social services. She compared the cost of the bill with the alternatives and considered that sometimes up-front costs saved more money in the future. She emphasized that the bill would put people in stable homes. She looked forward to updated fiscal notes. She was worried about the costs to the department but also thought the committee should consider the cost of not passing such legislation. SB 98 was HEARD and HELD in committee for further consideration. 9:44:53 AM AT EASE 9:45:11 AM RECONVENED