SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE February 23, 2000 1:35 p.m. MEMBERS PRESENT Senator Mike Miller, Chairman Senator Pete Kelly, Vice-Chairman Senator Gary Wilken Senator Kim Elton MEMBERS ABSENT Senator Drue Pearce COMMITTEE CALENDAR SENATE BILL NO. 256 "An Act relating to regulation of managed health care and allowing physicians to collectively negotiate with a health care insurer that has substantial market power." -MOVED CSSB 256 (HES) OUT OF COMMITTEE SENATE BILL NO. 228 "An Act relating to the financing of construction and major maintenance of public school facilities; authorizing the commissioner of revenue to sell the right to receive a portion of the anticipated revenue from a certain tobacco litigation settlement to the Alaska Housing Finance Corporation; authorizing the issuance of bonds by the Alaska Housing Finance Corporation with proceeds to finance public school construction and major maintenance grants; providing for the creation of subsidiary corporations of the Alaska Housing Finance Corporation for the purpose of financing or facilitating the financing of public school construction and major maintenance grants; relating to the annual public school construction and major maintenance grant application and approval process; providing for allocation of additional reimbursement of public school construction debt; and providing for an effective date." -HEARD AND HELD SENATE BILL NO. 224 "An Act relating to the confidentiality of investigations, court hearings, and court and public agency information in child in need of aid matters; relating to immunity regarding disclosure of information in child in need of aid matters; amending Rules 3 and 22, Alaska Rules of Child in Need of Aid; and providing for an effective date." SCHEDULED BUT NOT HEARD PREVIOUS SENATE COMMITTEE ACTION SB 228 - No previous Senate action. SB 256 - See HESS minutes dated 2/21/00. WITNESS REGISTER Jerry Reinwand Blue Cross Blue Shield of Alaska 2 Marine Way, No.219 Juneau, AK 99801 POSITION STATEMENT: Commented on SB 256 Mr. Jeff Davis Blue Cross Blue Shield of Alaska 2550 Denali St., Suite 600 Anchorage, AK POSITION STATEMENT: Commented on SB 256 Mr. Jim Jordan, Executive Director Alaska State Medical Association 4107 Laurel Street Anchorage, AK 99508 POSITION STATEMENT: Supports SB 191 Mr. Mike Haugen, Executive Director Alaska Physicians and Surgeons, Inc. 4120 Laurel Street, Suite 206 Anchorage, AK 99508 POSITION STATEMENT: Supports SB 256 Karen Rehfeld, Director Education Support Services Department of Education 801 W 10th St., Suite 200 Juneau, AK 99801-1894 POSITION STATEMENT: Presented and supports SB 228 Jim Baldwin Assistant Attorney General Department of Law PO Box 110300 Juneau, AK 99811-0300 POSITION STATEMENT: Answered questions about SB 228 Ms. Pat Weaver PO Box 877518 Wasilla, AK 99687 POSITION STATEMENT: Supports SB 228 Mr. Bob Dickens Bering Straits School District Box 225 Unalakleet, AK 99684-0000 POSITION STATEMENT: Supports SB 228 Marge Hays, Chair Older Alaskans Commission PO Box 2876 Soldotna, AK 99669 POSITION STATEMENT: Gave an update on the Older Alaskans Commission Jane Demmert, Executive Director Older Alaskans Commission Department of Administration PO Box 110209 Juneau, AK 99811-0209 POSITION STATEMENT: Gave an update on the Older Alaskans Commission ACTION NARRATIVE TAPE 00-7, SIDE A Number 001 CHAIRMAN MILLER called the Senate Health, Education and Social Services (HESS) Committee to order at 1:35 p.m. Present were Senators Pete Kelly, Wilken, Elton and Miller. Chairman Miller announced the committee would take testimony on bills until 2:30, at which time the Older Alaskans Commission will give a presentation. The first order of business to come before the committee was SB 256. SB 256-PHYSICIAN NEGOTIATIONS WITH HEALTH INSURE SENATOR WILKEN moved to adopt the proposed committee substitute for SB 256 (Version G) as the working document of the committee. There being no objection, the motion carried. JEFF DAVIS, Executive Director of Blue Cross Blue Shield of Alaska, made the following comments. From Blue Cross's perspective, the intent of SB 256 is to address inequities in bargaining power between physicians and insurers - however, Blue Cross's experience suggests that inequities are not the case in Alaska. Blue Cross began talking with Alaskan physicians in 1989 about potential agreements. Approximately 1,750 licensed physicians practice in Alaska. After 11 years of work, Blue Cross has agreements with approximately 700 physicians, which shows that Blue Cross does not have extraordinary market power in Alaska. Aetna, the largest insurer in the State, has made repeated attempts to negotiate contracts with physicians and, according to an Aetna source, as of yesterday Aetna has contracts with approximately 100 physicians. Blue Cross understands that, amongst the other insurers in the State, some may have a handful of contracts but most have none at all. MR. DAVIS repeated that Blue Cross does not have extraordinary market power in Alaska because it has been unable to convince any physicians in many specialties to join. He pointed out that Blue Cross has made numerous attempts to make easier interactions between physicians and Blue Cross members. Many physicians prefer to collect full payment upfront from the patient. Physicians agreed to bill Blue Cross directly and, in exchange, Blue Cross agreed to pay physicians directly. Many members appreciate that part of the agreement. Physicians also agreed to be credentialled by Blue Cross. That process is done using national committee for quality assurance criteria. The point of the credentialling process is to give Blue Cross members additional confidence in the physicians who are part of the network. Physicians also agreed to cooperate with Blue Cross's care management program. That program focuses on the appropriate setting of care for a particular member. MR. DAVIS noted that physicians also agreed to refer members to network providers, a point that was discussed by the committee at a previous hearing. He provided verbatim language from a standard Blue Cross contract which speaks only to hospitals and reads: The provider agrees to arrange for admission of preferred enrollees only to preferred hospitals provided that one is available locally and, in the professional judgement of the provider, admission to that preferred hospital will adequately provide the enrollee's medical care needs. MR. DAVIS said the decision as to where the patient's needs will best be met is left to the physician. MR. DAVIS stated the contracts also contain a 30 day termination clause for the protection of both parties. If at any time a physician says the agreement is not working, the physician can terminate the agreement, and vice versa. In his five years of experience, only one physician terminated because he did not want to fill out the credentialling paperwork. MR. DAVIS noted that Blue Cross is regulated by the Division of Insurance with respect to how it determines usual, customary and reasonable fees. Alaska statute requires Blue Cross to use Alaska data, adjust the data by region, and review it every six months. When Blue Cross looks at the data, it looks at each procedure code, known as a CPT 4 code. All charges in the 12 month sample are examined to determine, what physicians in Alaska have charged and where the 90th percentile lies. The contract says that if the physician's charge is less than the 90th percentile, then the entire charge is covered. If the charge is above the 90th percentile, the physician agrees to accept the 90th percentile and the member will not be billed for the additional amount. The contract results in members being protected from amounts over the usual, customary and reasonable fee. MR. DAVIS explained that Blue Cross identifies physicians who it wants to have a discussion with in several ways: through member requests, because of a gap identified in the network, or because physicians contact Blue Cross. Blue Cross usually makes contact by phone or in person. Blue Cross recently went through a push to recruit. Since last October, Blue Cross has contacted about 140 physicians. Of those, 33 declined immediately, 91 requested more information and are engaged in ongoing discussions with Blue Cross, and 15 have reached agreements. Regarding concerns raised about the federal employee program at the last meeting, MR. DAVIS said of the 105,000 Blue Cross members, 35,000 are federal employees. The rules for the federal employee program are set by the federal office of personnel management in Baltimore. SENATOR WILKEN asked if Blue Cross has a "hole" and has no contract with a surgeon, how much Blue Cross reimburses. MR. DAVIS said the terms of payment are dictated by the member's contract with Blue Cross. The member's contract could say that Blue Cross may pay 80 percent up to the allowable limit. The difference is if there is a contract, the member is not responsible for the amount over. If there is no contract, the balance is between the member and the physician. SENATOR ELTON asked if Bartlett Memorial Hospital is a preferred hospital. MR. DAVIS said it is. JERRY REINWAND, a lobbyist for Blue Cross, commented that Blue Cross has been unable to analyze what costs, if any, SB 191 will have on subscribers. Blue Cross is concerned about the rise in the medical consumer price index versus other consumer price indexes. Any changes that have the potential to impact the price of health care are of concern to Blue Cross. At Monday's meeting, a testifier made the statement that physicians are having a very difficult time with insurers, a statement which Blue Cross finds befuddling. MR. JIM JORDAN, Executive Director of the Alaska State Medical Association, explained the amendments made in the proposed committee substitute. First, the scope of the bill was increased to go beyond insurance plans. That change was made through the inclusion of intent language and by changing "health care insurer" to "health benefit plan." Two other changes were made. Blue Cross was concerned that only when negotiations involve fee related items does the mechanism kick in whereby the criteria for the substantial market share has to have been met by the insurer. Blue Cross is concerned about how the number of folks covered will be determined. That can take a great deal of work by a state agency. One of the amendments provides for a rebuttable presumption so that when a group of physicians, represented by an authorized third party, requests of the Commissioner of the Department of Labor that the process begin, the other party would be notified and given an opportunity to rebut that presumption if it chooses to do so. The last change adds a new section on page 10, AS 23.50.040, that allows a health benefit plan to initiate the negotiation process by making a request of the Commissioner when the health benefit plan wishes to discuss fee related items with a group of physicians when they do not have a substantial market share. This allows health benefit plans to initiate the process and voluntarily ask the commissioner to provide oversight and allow negotiations under the state action doctrine exceptions. SENATOR ELTON asked if physicians will be able to collectively negotiate fees with the state about the state's self insurance plan. MR. JORDAN said it will and said he discussed that topic at length with the drafter who created the mechanism. SENATOR ELTON asked about the fiscal note. CHAIRMAN MILLER pointed out the bill will be reviewed by the Senate Finance Committee. SENATOR ELTON asked whether the 30 percent requirement on page 8 pertains to the physicians in a particular specialty and whether it only kicks in if the health benefit plan has more than five percent of the local market. MR. JORDAN said not quite. He indicated it means that an authorized third party may not represent more than 30 percent, however, an authorized party may represent more than 30 percent if the health benefit plan has more than five percent of the market share in a particular area. The reason that provision was included is because of concern for rural areas where there may be very few physicians. SENATOR ELTON asked what the effect is of this provision on small health care plans that do not have more than five percent of the market share in a local community but where another health plan may have more than five percent. He expressed concern that a small insurer, who has less than five percent, may be driven out of the market. MR. JORDAN said that is why the bill was changed to allow for voluntary participation. There are circumstances in which a small insurer may not have that market share but can ask for oversight under AS 23.50.040 (page 10, lines 8-10). SENATOR ELTON said the bill essentially says a small health care plan either conforms or disappears because the market threshhold would be difficult for them to meet. MR. JORDAN said that is correct but he does not see how they would disappear because they would be allowed to voluntarily enter into negotiations. SENATOR WILKEN asked who authored the document entitled, "Response to Comments by Gordon Evans" in committee members' packets. MR. JORDAN said he wrote it. MR. MIKE HAUGEN, representing Alaska Physicians and Surgeons, stated that, in his opinion, Blue Cross is not the issue. The issue is freedom of communication between doctors to discuss patient protection and physician issues and managed care contracts. Without the protections offered by this bill, physicians are effectively gagged from discussing terms of contracts among themselves, and not just the financial aspects. If the contracts were about the financial aspects only, they would be one-half page long. A typical contract is 15 to 20 pages. While it is true that Blue Cross has negotiated term changes with some of the 700 contracts, many physicians have told him that because of Blue Cross's large footprint in Alaska, they have to sign the contract as is because they cannot afford to lose that much business. The physicians in Fairbanks have incurred huge legal fees and had to undergo one year of FTC scrutiny because of an anonymous complaint phoned into the FTC. Under the current messenger model it is too easy for a party with an axe to grind to notify the FTC and claim that doctors are trying to boycott or price fix. SB 256 requires state oversight to ensure that physicians are not boycotting or price fixing. Again, the process is voluntary on everyone's part. SENATOR PETE KELLY moved CSSB 256(HESS) with its accompanying fiscal note to the next committee of referral. SENATOR ELTON objected and said that intellectually, he does not have a problem with people getting together and bargaining as a group and that he will vote to move it on but he is very interested to see what the Finance Committee finds. SENATOR KELLY thought Senator Elton's concerns are valid and will create a change, but he remarked the entire health care industry is changing by quantum leaps. Alaska's doctors are quite isolated and many of them are attached to a few health care plans, so they are at a disadvantage to city doctors in other states. Other states are choosing to go with this model as well. CHAIRMAN MILLER agreed that both comments are valid and that the legislature needs to know what all of the ramifications of the bill will be. He noted that since less than 80 days are left in this session, it is time to move the bill on so that some of the questions can be answered by the Finance Committee. CHAIRMAN MILLER announced that with no further objection, CSSB 256(HES) moved from committee. SB 228-PUBLIC SCHOOL CONSTR/MAINTENANCE FUNDING MS. KAREN REHFELD, Director of Education Support Services for the Department of Education and Early Development, made the following comments on behalf of Commissioner Cross. SB 228 provides a funding mechanism for school construction and major maintenance projects over the next three years. With over $1 billion investment in school facilities in this state, Alaska cannot afford to neglect major maintenance needs or replacement of schools. DOE has consistently advocated for a long term stable source of funding for school construction and maintenance projects. SB 228 will address three goals. First, it will provide adequate, safe places to learn by clearing up the backlog of major maintenance projects statewide. Second, it will address the needs of both urban and rural school districts with an emphasis on addressing major maintenance projects quickly to avoid more costly construction costs in the future. Third, it will address the concerns brought forward in the Kasayulie lawsuit. The package totals $510 million, including $360 million in grants for school construction and major maintenance, and $150 million for school debt reimbursement. The projects included in the Governor's package are funded in the order in which they are ranked on the department's priority list. As proposed, all 86 projects on the current major maintenance list and 40 of the 69 new construction projects will be funded. The current list would be frozen over the next three years while these projects are underway. MS. REHFELD continued. The rationale behind the legislation is based on these goals, and sticking to the priority list and completing as many projects as possible over the next three years. Adjustments to the amount of funding for particular projects and the final listing will need to be made as a result of appeal decisions that are currently before a hearing officer as it relates to the priority list. The State Board of Education will be meeting in March to finalize the school construction and major maintenance list. As the State continues to address the issues raised in the Kasuylie case, there may be further modifications needed. Funding for major maintenance and school construction projects is critical in both rural and urban Alaska. SB 228 goes a long way toward addressing those needs. SENATOR ELTON asked if the State Board of Education will have the opportunity to change the list before it is frozen when it meets in March. MS. REHFELD explained school districts may appeal DOE's annual ranking decision as it was released in December. Those appeals are then reviewed by a hearing officer. The hearing officer's decision is taken to the State Board of Education who finalizes the list. DOE plans to bring those changes back to the Legislature to incorporate into SB 228. SENATOR ELTON asked if the only anticipated changes to the list will be those modifications made under the appeal process. MS. REHFELD replied yes, any of the specifics of the funding of those projects as they are resolved by the hearing officer. SENATOR WILKEN recalled that at the December Bond Reimbursement Committee meeting, the major construction list totalled $199 million, and the major maintenance list totalled $49 million. He asked if that list was added to since December. MS. REHFELD said she did not recall the date of the December Bond Reimbursement and Grant Review Committee meeting, but DOE issued a list on December 15 that would have changed somewhat based on reconsideration of its November list. By statute, DOE is required to release its initial priority ranking by November 5. School districts then have the opportunity to ask for reconsideration. A new list is published on December 15 and it is that list the school districts would formally appeal. SENATOR WILKEN thought the Bond Reimbursement Committee met on December 9. He asked Ms. Rehfeld the total of the school construction projects in SB 228. MS. REHFELD replied the bill authorizes $360 million for all of the projects on the major maintenance list and a portion of the new construction list. SENATOR WILKEN said he would check but he recalls a total of $250 million. He asked Ms. Rehfeld to discuss the source of funds for the projects in SB 228. JIM BALDWIN, Assistant Attorney General, explained the bill contains two sources of funding for bonds that would be issued by the Alaska Housing Finance Corporation (AHFC). The first would be the authority of the State to sell the right to receive a stream of revenue generated by the tobacco settlement. That amount is expected to be $260 million. The additional $100 million would be generated from the general obligation bond capacity of AHFC. The total in the bill equals $369 million because additional amounts are needed for reserve funds and things of that nature in order to make the bonds marketable. This is within the agreement that was entered into with the Legislature in 1998. Another piece of legislation that will be tied to this will be the capital budget. DOE expects the Legislature will then go forward and appropriate for these particular projects in the capital budget. Securing the tobacco settlement stream is a device that has been used in other jurisdictions. It will be helpful to the State's position in the Kasuylie case if a large amount of financing is devoted for rural schools. This type of financing device allows for more of a concentration on rural schools. Another element of this bill provides for further authorization for the bond reimbursement program - that part of the package totals $150 million. SENATOR WILKEN suggested the Kasuylie case is not a reason for the Legislature to be considering this legislation. He asked if the Administration is doing anything to change the system so that the REAAs can help participate in the construction of their schools. MS. REHFELD said there is no proposal at this point that provides for a bond capacity or some other mechanism for REAAs to participate. SENATOR WILKEN asked if SB 228 contains a provision to develop a prototype school or school program. ASSISTANT ATTORNEY GENERAL BALDWIN said nothing in SB 228 expressly provides for prototype schools but nothing prohibits them. SENATOR WILKEN asked if DOE would object if such a provision was added. ASSISTANT ATTORNEY GENERAL BALDWIN said from the perspective of the lawsuit, he does not know whether that might complicate things. TAPE 00-8, SIDE B MS. REHFELD replied that has been an issue that the Bond Reimbursement and Grant Review Committee has been looking at and she is not sure that it has actually come up with an approach that captures all of the aspects of dealing with prototype schools. CHAIRMAN MILLER indicated a number of schools on the project list are within organized boroughs and asked if the amount included in the bill is the state's approximately 70 percent share. MS. REHFELD said if the Chairman is speaking specifically to the grant projects that are included in the proposal, all school districts have a required participating share. CHAIRMAN MILLER asked if these projects are funded with 70 percent by the State. MS. REHFELD said yes, or whatever the participation level is. SENATOR ELTON asked Assistant Attorney General Baldwin whether he feels reasonably assured that this approach will satisfy the plaintiffs. ASSISTANT ATTORNEY GENERAL BALDWIN said he is comfortable that the amount of $360 million to address the projects included in the bill is highly likely to resolve the problems in the claims in the case, whether it be by settlement or whether it be by making the case moot. He said he respects Senator Wilken's view on the Kasuylie case, and that view is shared by the Governor, but in the discussions he has had with the plaintiffs, they are in general agreement on the dollar amount and on the projects. There is an ongoing discussion, however on how much will be spent on each project. SENATOR ELTON said he thought the amounts were settled and equalled 100 percent of the new construction and major maintenance. MS. REHFELD said in the Governor's proposal, several of the projects from the December 15 meeting that were initially recommended to be phased are recommended to be fully funded. To the extent that one would be able to go farther down the list if the projects were phased or, conversely, try to fully construct as many projects as possible, that would affect how far down the list one can go. Because the proposal would freeze the list for three years, DOE believes it is better to get as many projects completed as possible during that three year period. Under this proposal, there would be nine projects in year three that would be phased. After the first year, those projects would receive additional points toward ranking because the planning and design phase would be complete. The goal is to try and complete as many projects as possible. MS. PAT WEAVER, a PTA member from Mat-Su, stated support for SB 228. She supports funding the statewide projects from tobacco settlement money, and she believes students need clean, safe water. She also supports debt reimbursement of 70 percent. SB 228 is a "no frills" bill. MR. BOB DICKENS, Bering Straits School District, commented that SB 228 is a long-awaited development in addressing the public school construction in rural and urban Alaska. The biggest problem he has seen over the last seven or eight years is that there has been no consistency in the funding, especially in rural Alaska. SB 228 is a big step in that direction. In the long run, it will give rural residents the hope they have been looking for during the past seven or eight years. SENATOR WILKEN congratulated Mr. Dickens for keeping the school in Golovin in first class shape. He pointed out that the Bering Straits School District has three schools on the list. He asked if that school district would be amenable to having three prototype schools constructed in those three villages. MR. DICKENS noted that five schools would be constructed in the Bering Straits School District over a three year period: Golovin, Elim, White Mountain, Koyuk, and Teller. Regarding prototype schools, Bering Straits School District is more in favor of standardization of equipment and mechanical systems because each location has a unique terrain. CHAIRMAN MILLER thanked all participants for testifying on SB 228 and noted his intent to take more testimony next Wednesday and to pass the bill from committee at that time. Number 870 MS. MARGE HAYES, Chair of the Older Alaskans Commission (OAC), introduced other participants and Commission members: Alison Elgee, Don Hoover, Doris Bacus, Jesse Gardner, Dan Karmun, Bill Hermann, Ella Craig, Peggy Burgin, Kay Branch, and Bob Gregovich. MS. HAYES said the Commission's focus is the continuum of care for elderly Alaskans. Most seniors are remaining in Alaska instead of leaving, plus most seniors are living longer, so the population is growing. A lack of services for that population impacts seniors and their family members as well. The least expensive way to go is the home and community-based end of the continuum. At a Common Ground Conference held in Anchorage recently, the goals expressed by seniors are that they want to retain their independence, dignity, and to stay connected to their communities. As the continuum of care goes up, assisted living homes provide more help. They cost more than the cost of remaining in one's home, but are less expensive than living in a nursing home. She noted that half of the people sitting in the committee room will end up with Alzheimer's Disease if they live to the age of 85. The OAC is trying to plan ahead and is collaborating as much as it can with the other beneficiary groups of the Alaska Mental Health Trust Authority (AMHTA). MS. JANE DEMMERT, Executive Director of the OAC, reviewed the materials contained in a packet provided to committee members: OAC's current state plan, its last annual report and the agenda of the current OAC meeting. MS. DEMMERT gave a brief summary of information in the packet. The chart on page 3 shows that the projected population of Alaskan seniors in 25 years will be 125,000, a five-fold increase. A chart on page 4 shows the estimated prevalence of Alaskans affected by Alzheimer's Disease and Related Dementia. That population is estimated to number more than 15,000 in 25 years. Prevalence estimates also show that nationally, 10-15 percent of older people experience alcohol misuse. The Division of Alcoholism suspects that the rate of late-stage alcoholism is doubled in Alaska. Medication misuse affects 1/3 of the senior population. Unfortunately, negative interplay between the chemistry of different medications can occur in people who take several medications. Mental health issues also affect an estimated 15 to 25 percent of elderly Alaskans. Proper support and treatment can ameliorate depression and other more severe mental illnesses. MS. DEMMERT pointed out that critical needs can compound for older Alaskans, especially when they are affected by factors such as dementia, mental illness, substance abuse, and medical problems. Intervening before difficult and challenging circumstances occur is not only humane but cost effective. Page 8 shows what services are available and where there are gaps in those services. Older Alaskans, their families, and the OAC share the common goal of easing or remedying complications before they become acute and cause extraordinary stress to the individual and family. In so doing, a personal and family crisis is avoided, as is dislocation of a family elder and often extraordinary expense. Each week that a person can stay in a lower cost assisted living facility instead of a nursing home generates at the national level $100 to $600 per week in savings. The savings in Alaska would be more pronounced because the nursing home costs are higher. On a national level, delaying nursing home placements for one month could result in a savings of $1.12 billion per year. MS. DEMMERT said that caregiving is emotionally and physically demanding, although immensely rewarding. One of the supports that OAC has in some areas of the state, through grants to the Alzheimers Association and through senior centers, is counseling and support groups for caregivers. The isolation that can occur for the caregiver and the patient can be deadly. OAC is finding that when an adult day service is available, the caregiver can be employed elsewhere. That helps the family economically and gives the caregiver social interaction, while the adult day care is therapeutic for the patient. Of all of the different kinds of care the Legislature invests in, 40 to 70 percent is paid for by grants that come through the State. In addition, a tremendous amount of the funding is being generated by local governments. MS. DEMMERT pointed out that the Division of Senior Services operates two Medicaid waivers for home and community based care. Based on a close review of Medicaid waiver data collected in FY 98, it is estimated that almost $25 milllion was saved by providing home and community based care as opposed to nursing home care. Adult daycare programs exist in 11 communities in Alaska. Information and education services are in place in Anchorage, Fairbanks and Juneau through the Alaska Alzheimers' Association. Care coordination services are avilable in some communities and regions to assess a person's social and medical needs, rather than just the medical needs. Often a person could remain at home if they can get help with something as simple as bathing, eating, or getting up in the morning. MS. DEMMERT informed committee members that worksessions were held at the Common Ground Conference about what people hope to experience during their later years. The hopes were simple, yet profound. Seniors hope to remain in their homes and community, to stay connected, to be safe, to be healthy, to maintain financial self-sufficiency, maintain independence, and to live with dignity. Seniors need a strategic continuum of care that integrates nutrition, transportation, supportive services, housing, and home and community-based care, including assisted living and nursing homes. MS. DEMMERT said legislators can make a difference by providing a reasonable continuity of benefits. HB 161, which prorates benefits, is truly unpredictable and could profoundly change the possibilities of a person remaining self-sufficient. Second, cuts to public services provided through municipal revenue sharing impacts people who are vulnerable. Property tax exemption is one of the tools that allows seniors to live independently. AHFC, in relation to senior housing programs, is absolutely essential to meeting housing needs. Last, SB 204 extends the sunset date for the OAC. SENATOR WILKEN clarified that John Hatchen is the Vice Chair of the Long Term Care Task Force and that Representative John Coghill is a member. He also informed Ms. Demmert that a group in Fairbanks, named "Gaps in Care" is comprised of assisted living workers and nurses who are trying to keep people in their homes and out of institutions. He suggested that Ms. Demmert make contact with the group. There being no further business to come before the committee, CHAIRMAN MILLER thanked participants and adjourned the meeting at 3:05 p.m.