SENATE BILL NO. 57 "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." 9:45:58 AM TONY NEWMAN, DIRECTOR, SENIOR AND DISABILITIES SERVICES, DEPARTMENT OF HEALTH, discussed the presentation, "State of Alaska Department of Health" (copy on file). He looked at slide 2, "Senior and Disabilities Services Medicaid Home and Community Based Waivers": • Allow people with disabilities and seniors to remain in their homes or local community settings when they would otherwise need institutional care • Home and Community Based Waivers receive a 50% Federal and 50% General Fund Match • Alaska provides five home and community-based waivers: •Intellectual and Developmental Disabilities waiver (serving about 2,000 people) •Alaskans Living Independently waiver (2,200 people) •Children with Complex Medical Conditions waiver (225 people) •Adults with Physical & Developmental Disabilities waiver (144 people) •Individualized Supports waiver (500 people) Mr. Newman looked at slide 3, "Services available under Alaska's Medicaid Home and Community-Based Waivers": • Residential Habilitation (Group Home, Family Home Habilitation) • In-Home Supports • Supported Living • Day Habilitation • Adult Day Services • Respite • Supported Employment • Transportation • Environmental Modifications • Meals • Specialized Medical Equipment • Nursing Oversight • Intensive Active Treatment • Specialized Private Duty Nursing Mr. Newman pointed to slide 4, "Options for 24/7 residential care for people on Medicaid home and community- based waivers": Assisted Living Home Available for four waivers Alaskans Living Independently (ALI) Alaskans with Physical and Developmental Disabilities (APDD) Intellectual and Developmental Disabilities (IDD) Children with Complex Medical Conditions (CCMC) Number of residents only limited by size of facility Multiple administrative requirements Varying staffing patterns possible Adult Care Home (proposed) Available for four waivers: Alaskans Living Independently (ALI) Adults with Physical and Developmental Disabilities (APDD) Intellectual and Developmental Disabilities (IDD) Children with Complex Medical Conditions (CCMC) 1 to 2 residents Less administrative requirements Live-in caregiver 9:52:25 AM Co-Chair Olson wondered how many other states had a similar model, and how successful were those states. Mr. Newman replied that many states had the model, but most called the program different names. He stated that it was determined that it was a positive situation. Senator Kiehl surmised that the bill did not limit to people aging out of the foster care system. Mr. Newman agreed. Senator Kiehl wondered whether it was a new form of care, or filling a limited gap. Mr. Newman replied that the goal was for two people to live together, but it allowed for up to three people. Senator Kiehl asked for a definition of "unusual circumstances." Mr. Newman replied that the situation would be for three disabled people to want to stay together. 9:55:11 AM Co-Chair Olson wondered whether there was an age limit. Mr. Newman replied that any qualified individual over 18 was eligible for the service. Senator Kiehl wondered who would draft the plan of care. Mr. Newman replied that the plan of care was set up by the recipient with help from a care coordinator and approved by the department. Senator Kiehl asked where the type of care home would have an exemption. Mr. Newman responded that Section 4 would add it to the setting list. Senator Kiehl noted that the department had recently expanded its definition of "assisted living home" for a number of facilities, so he hoped that it would not take away care. Co-Chair Olson queried the difficulty in receiving a license. Mr. Newman replied that Mr. Nave would be able to reply to that question. 9:57:48 AM ROBERT NAVE, PROGRAM MANAGER, DIVISION OF HEALTHCARE SERVICES, DEPARTMENT OF HEALTH, ANCHORAGE (via teleconference), explained that the process to obtain a license was not very cumbersome for providers. Co-Chair Olson queried the difficulty for rural residents to obtain a license. Mr. Nave stated that the objective for the bill was to relieve that difficulty. Mr. Newman agreed. 10:00:08 AM Mr. Newman provided an overview of the fiscal notes. Senator Bishop wondered why the positions could not be located in Anchorage. Mr. Newman replied that they could be in Juneau or Fairbanks. 10:03:19 AM Co-Chair Olson OPENED public testimony. 10:03:48 AM MICHELE GIRAULT, EXECUTIVE DIRECTOR, HOPE COMMUNITY RESOURCES, ANCHORAGE (via teleconference), spoke in support of the bill. 10:05:52 AM JAMIE KOKOSZKA, PROGRAM COORDINATOR, COUNCIL ON DISABILITIES AND SPECIAL EDUCATION, PALMER (via teleconference), testified in support of the legislation. 10:08:46 AM Mr. Nave stated that he did not need to testify. 10:09:02 AM PAMELA SAMASH, ALASKA COMMISSION ON AGING, NENANA (via teleconference), spoke in support of the bill. 10:10:56 AM MICHAEL JEFFERY, SELF, UTQIAGVIK (via teleconference), testified in support of the bill. 10:13:35 AM MARGE STONEKING, ADVOCACY DIRECTOR, AARP, ANCHORAGE (via teleconference), spoke in support of the legislation. 10:16:16 AM KIM CHAMPNEY, DIRECTOR, ALASKA ASSOCIATION ON DEVELOPMENTAL DISABILITIES, spoke in support of the bill. Mr. Newman thanked the committee for hearing the bill. Senator Merrick wondered whether people had to pay to become licensed as an assisted living home. Mr. Newman replied that there was a small license fee, and the bill proposed to eliminate that license fee. 10:20:18 AM Senator Kiehl queried the definition of "business site" in Section 5. Mr. Newman agreed to provide that information. Mr. Nave replied that there was requirement that stated that no other business could be run from the home other than the assisted living business, without the approval of the department. SB 57 was HEARD and HELD in committee for further consideration.