Legislature(2003 - 2004)
02/24/2004 03:06 PM House HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HB 394-COMMISSION ON AGING Number 0050 CHAIR WILSON announced that the first order of business would be HOUSE BILL NO. 394, "An Act extending the Alaska Commission on Aging." Number 0092 REPRESENTATIVE GATTO moved to adopt CS HB 394, 23-LS1534\D, Mischel, 2/19/04, as the working document. There being no objection, HB 394, version D, was adopted as the working document before the House Health, Education and Social Services Standing Committee. Number 0155 BARBARA COTTING, Staff to Representative Jim Holm, Alaska State Legislature, presented the bill on behalf of Representative Holm, sponsor of HB 394. She explained that the committee substitute that the members just adopted as the working document adds sections 2 and 3 to the original bill. The original bill was very short because it consisted of one section that extended the sunset [of the Alaska Commission on Aging]. MS. COTTING explained that in 2003, Executive Order 108 moved many commissions to different departments. It is important to note that at that time the Commission on Aging was moved from the Department of Administration to the Department of Health and Social Services. Legislative Legal and Research Services believes that it is important to clarify that point and that is the purpose of sections 2 and 3, she said. It is just a housekeeping measure. Number 0260 STEVE ASHMAN, Director, Division of Senior and Disability Services, Department of Health and Social Services, testified in support of HB 394 and answered questions from the members. He explained that the division administers grant programs under the Older Americans Act. These programs used to be administered by the Commission on Aging, he added. The division has been working very closely with the Commission on Aging as the reorganization progresses, Mr. Ashman stated. He explained that since the Alaska Commission on Aging was created in the late 1970s, it has done a great job of meeting the needs of the elderly, and [the administration] supports its continuation. Number 0302 REPRESENTATIVE COGHILL commented that he read the legislative audit report [on the Alaska Commission on Aging, dated October 1, 2003] which was done before the commission was moved from [the Department of Administration to the Department of Health and Social Services]. Representative Coghill said that he is concerned with the grant making process and asked Mr. Ashman to explain the changes that have been made to that process. He told the committee that he had the auditor come to his office and discuss the report with him. Representative Coghill noted that the auditor is at the meeting today should there be need for clarification. Number 0372 MR. ASHMAN replied that he has also read the audit report. He said he believes the problems that Representative Coghill is referring to occurred in fiscal year 2002, when the program was over at the Division of Senior Services in the Department of Administration. The first problem pertains to the Senior Employment Program, [which was authorized] under federal law. The program was supposed to be providing temporary training services to older Alaskans, 55 years old or older, to enable them to reenter the workforce, he said. However, what happened was that many of the grantees were using those employees to fill long-term positions within its organizations. This [practice] was clearly against federal legislation, he stated. The division has changed that practice, although some latitude has been extended in rural areas where there is a lack of employment opportunities. Mr. Ashman commented that approximately 80 percent of the seniors [in this program] are [moving from training to employment] within six months, which means the state is now in compliance with federal laws. There are still some grantees that are administering the program, he acknowledged; but assured the committee that the division is keeping an eye on them. Number 0501 MR. ASHMAN said he believes another problem the report cited was the lack of reporting to ensure that the use of federal funds was in compliance with federal program requirements. He commented that the issue was the lack of on-site audits. A plan was put together two years ago to focus on those two areas and he told the members that he believes the division is on target. REPRESENTATIVE COGHILL asked Mr. Ashman to confirm that [$13] million in federal funds are administered through this program. He asked what portion of those funds are general funds dollars. Number 0574 MR. ASHMAN replied that historically the state's match is about 24 percent in general funds. The minimum match requirement is 15 percent. He pointed out that in the division's budget this fiscal year there is a $200,000 reduction in general fund contributions because grantees will be asked to pay 10 percent. Mr. Ashman explained that currently between 95 percent and 98 percent of the grantees do have a 10 percent cash match. The state picks up 15 percent and the federal government covers the balance. REPRESENTATIVE COGHILL asked if the movement of the division from one department to another has changed its mission. MR. ASHMAN responded that there is no change [in the mission] of the Alaska Commission on Aging because the mission was established under the Older Americans Act which created the Commission on Aging, formerly the Older Alaskans Commission. The only change that has occurred in this reorganization is the removal of grant making ability from the Alaska Commission on Aging and transferring those duties to the Division of Senior and Disability Services. The Department of Health and Social Services has some very well defined procedures in how the grant process works, whereas the Department of Administration did not have that type of process in place, he added. REPRESENTATIVE COGHILL asked if there will be a change in accountability. MR. ASHMAN explained that while the Commission on Aging will not be making any grants, the state plan is developed by the Executive Director of the Commission on Aging, and then is presented in a series of public meetings. The Commission on Aging finalizes the plan and presents it to the governor for approval. In that plan is the intra-state funding formula which says how the funds will be distributed statewide, so the commission is key in that respect, he said. Mr. Ashman emphasized that the commission will not be [awarding] any grants. The division will work with the commission closely to ensure that the grants are being managed consistently with the desires of the Commission on Aging and the state plan, he added. REPRESENTATIVE COGHILL commented that he misunderstood a commission member's testimony in the House State Affairs Standing Committee [on that point]. He asked if the commission members look at allocation parameters. MR. ASHMAN responded that the commission members look at the intra-state funding formula that is included in the state plan, and which identifies the priorities and areas where funding will go. REPRESENTATIVE COGHILL asked if the commission members are made up of regional representatives or are the members appointees. Number 0784 MR. ASHMAN responded that according to Alaska law the commission members are appointed by the governor. No geographical representation is required, he added. However, over the past 15 years that he has been associated with the commission, there have always been representatives from both the rural and urban areas of Alaska. One requirement for appointment is that members must be a user of services either under the home community-based Older Americans Act programs and/or the Medicaid programs. In summary, he said there is good representation statewide. Number 0833 MS. COTTING directed the members' attention to the handout in the members' packets from the Office of Boards and Commissions which highlights the requirements of members. She said part of those requirements read as follows: Appointments shall be made to assure representation of low-income and minorities and rural/urban areas and statewide geographical representation. MS. COTTING stated that the requirements are well defined in the Boards and Commission statute. CHAIR WILSON referred to the Legislative Audit report [dated October 1, 2003, page 17, paragraph two] which read: We continue to recommend the agency establish and follow procedures to ensure that costs reported by subrecipients comply with federal requirements ... CHAIR WILSON said one point that was noted [in the report] was that there was a lack of periodic site visits. She asked Mr. Ashman what specific steps he has taken to ensure that concern is being addressed. Number 0915 MR. ASHMAN responded that under the corrected plan the division put together, desk audits are being done. He noted it was not being done before. He agreed that the last two audit reports cited the lack of periodic site visits as a problem. Mr. Ashman explained that there are 78 grantees and the division has a staff of 3, so it is not physically or financially possible to visit every grantee every year. The visits are being done on a rotation basis; however, desk audits are being done [regularly]. He told the members that whenever someone else from the Division of Senior and Disability Services happens to be in a particular community, the division is making an effort to visit the grantees while there. There may not be a review of the books at that time, he commented. Mr. Ashman emphasized that there have been increased audits over what was done in previous years. Number 0963 CHAIR WILSON commented that there have been several statements made that in the grant process there was a bias in the awarding of grants. She asked Mr. Ashman to address those [charges]. MR. ASHMAN explained that in FY 04 and FY 05 a new state plan needed to be developed. Part of that plan is the intra-state funding formula which is based on census information. The previous census information and plans were based upon the 1990 census. When the new census came out there was a redistribution of [funding based on] senior citizen [populations]. For instance, there may have been a higher growth of seniors in one region over another region, so the funding formula changed. There were winners and losers financially. He surmised that there could have been some grantees who had been receiving more funding under the 1990 census, but then lost funding with the new census report. Mr. Ashman emphasized that the number of seniors has increased in all areas. The Commission on Aging requested that rather than having communities take the whole hit in one year, it was requested that the federal government allow a phase-in of that [redistribution in a] three-year plan. He summarized that he does not believe the grantees had a problem with the process, but rather with [the way the census impacted] the outcome. CHAIR WILSON asked Mr. Ashman if he could confidently tell her that there will be improvement. MR. ASHMAN assured Chair Wilson that there will be improvement. Number 1097 REPRESENTATIVE CISSNA told Mr. Ashman that an hour or two ago she listened to seniors who had teleconferenced in to a meeting from ten or more communities. She was told that Alaska has the second fastest growing aging population in the United States, second to Nevada. Seniors now make up something like 6 percent of the population, she said. Representative Cissna commented that in not many years it will grow to 12 percent. These seniors told of the gaps in services for conditions such as Alzheimer's disease. She asked how Mr. Ashman views this growing problem. Number 1188 MR. ASHMAN agreed with Representative Cissna's comments. The Alaska Commission on Aging and the local senior networks are looking at what level of services are being provided currently. Once that assessment is made, the [program] can be tailored to meet the needs of the community. The division will be looking to see where the funds are being spent and pointing out that, for example, 52 percent of funds are being spent on transportation services and then assure that is where the need is for a particular community. Some of the senior networks may not be aware of the way funds are being spent. Mr. Ashman said that the division and the commission will be having those discussions on a local level. REPRESENTATIVE COGHILL noted that it is helpful to understand that this is an evolving plan and a change of administration. He asked how these changes impact the scrutiny of grants. Are there any major changes in the delivery of the plan. Representative Coghill stated that based on what he has heard, he is still not satisfied that he understands what the changes will be. MR. ASHMAN responded that he is not sure what Representative Coghill is asking. He commented that when working with the grantee agencies, the division will be saying historically here is where the funds have been used and the types of services [provided] in this particular market. The division will be asking if these services have been meeting the needs of the community. Mr. Ashman noted that many of the grantees are Medicaid waiver providers and the division will work to ensure that they are maximizing the funds received. He assured Representative Coghill that the division has regulations that will be followed to ensure that those receiving the grants administer them appropriately, and that the grantees are submitting reports on time before any advances are provided. Number 1559 REPRESENTATIVE COGHILL asked how this plan fits with the home and community-based waiver program, assisted-living homes, and the huge network of agencies out there. Obviously, he said, this group is very attuned to the needs of the communities. He told Mr. Ashman he would like to have some clarity in how the needs are being identified and how the grants meet those needs. For example, doesn't the commission look at the number of people and the limited number of dollars to meet those needs, and then evaluate what is the wisest expenditure of those funds. He asked if there is any change in the way these points are examined. MR. ASHMAN responded that the division will take a look at what services are being provided currently in a community and make sure the services that are needed [are met], and if not, what kind of changes need to be made [to address those deficiencies]. Mr. Ashman commented that he believes that is a local issue that the division will be working on to assure the right services are being provided. This will be done in conjunction with the division and the commission because while the division administers the grant programs; it is the commission that puts together the state plan, reviews it, does the public comment, and works with the local communities. The commission will work side-by-side with [the division]. Ultimately, the state plan is the plan that is submitted by the governor, he stated. He added that the division will ensure that the administration of grants are in compliance with that state plan. REPRESENTATIVE COGHILL said he would like some clarification on where the commission's [duties] start, where the administration's [duties] start, and at what point it converges. How do to the two work together, and is there tension between the two, he asked. MR. ASHMAN told the committee that under Alaska statutes the executive director prepares the state plan. The Older American Act requires a state plan and a senior advisory committee, which in Alaska is the Alaska Commission on Aging. The executive director works for and is hired by the Alaska Commission on Aging, subject to the governor's appointment because it is a partially exempt position. He reiterated that the executive director puts together the plan in conjunction with the desires of the commission. After the plan is developed, the commission spends approximately six months conducting public hearings on that plan. The comments and feedback received in those public hearings are incorporated into the plan, he said. REPRESENTATIVE COGHILL asked if the division's move from the Department of Administration to the Department of Health and Social Services affects how the plan works. Has the move impacted how different agencies work together. Representative Coghill asked how the plan affects people at home. Are there changes in the categories that are being offered, he asked. MR. ASHMAN responded that the reorganization does make sense because the division is the "one-stop-shop" for all long-term care services. The Division of Senior and Disability Services not only manages the Medicaid Waiver Program, but also the other three long-term care options. He said the division is looking at the broader picture of how all these programs fit together to make sure the needs are being met with whatever types of programs are available. He said that he would not want to see the division go into a community and tell it that it needs respite [care], for example. He said he wants the division to say to a community here's what is currently offered; here's what's available; ask what is working and what is not; and offer some programs that are available to meet the needs of seniors in the community. Number 1678 REPRESENTATIVE COGHILL said that he still needs further clarification on the grants issue before he can vote for the reauthorization of the Alaska Older Alaskans Commission. MR. ASHMAN replied that, for example, when there are Title III funds [available] for nutrition transportation services (NTS), it is the grantees that comes to the division with a proposal. The division knows how much money is available based on the inter-state funding formula. So regionally it is known how much money can go into that particular region, he said. It is the grantee that tells the division how much it wants to spend on transportation, information referral, and other categories. Within the big picture, it is the grantee that is deciding what level of services are being made. He told the members that the question the division has is when there are multiple grantees within a particular region, do the grantees all know what's going on, and are the dollars that are being spent the best use of those funds. Number 1743 REPRESENTATIVE COGHILL said that the need is great and he wants to ensure that he has a clear understanding of the plan. He said he has one other question which he believes cannot be answered in this committee, but which he would welcome suggestions from Mr. Ashman. He said he is aware of the fact that there is a huge federal dollar contribution, and a huge amount of federal money that does not go through the state, but goes directly to the community. Representative Coghill said his concern is that many of these dollars are going into the same service market for similar needs. He said he wants to make sure that one funding source is not competing with another source in the same market. Number 1797 CHAIR WILSON commented that she is concerned because funds are so limited and seniors are so precious to Alaska. She asked Mr. Ashman where the lieutenant governor's faith-based initiatives fits into this. Chair Wilson said that what neighbors and family use to do for each other, is no longer being done on a volunteer basis because it is being paid for. She added that she is concerned that something is driving this machine. Chair Wilson asked if the division is looking at encouraging volunteerism. For example, there are many things such as grocery shopping, babysitting, and household chores which could be done free of charge by a volunteer. She encouraged this kind of volunteerism so that the things that really need to be paid for can be funded in a larger scope. In some cases, grandma use to baby-sit for free, but now she's being paid. Chair Wilson's said it is not that she doesn't want grandma to have some extra spending money, but that when money is spent on things that could be accomplished through volunteerism it may not be possible to fund things that are really needed. MR. ASHMAN replied that one of his staff is assigned to the lieutenant governor's faith-based initiatives. He said he believes that many would be surprised at the number of grantees that are working with the same [faith-based] organizations. For example, if it is known that a particular person does not have any food in their cupboard, a faith-based organization will provide that. Faith-based organizations, through the 501(c)(3) or nonprofit status, will participate in some of these same programs that the division has. Number 1922 MR. ASHMAN shared his concern that what [families and neighbors] use to do for each other seems to be shifting somewhere else. He said that he believes that many have heard about the regulatory changes that reflect cost-containment measures in the division's budget to eliminate some of those expenses. There are instances where the division is paying for respite services to a paid family member, so they can go out and provide services to someone else. The division is saying that it will not respite a paid care provider, he commented. There is a higher dependence on family members, in that the division is eliminating the use of respite and chores services and saying that if there is someone in that household who can provide those services, then he/she needs to be doing them. Our proposed regulations [which reflect those changes] have gone out to the public for comment, and should be adopted shortly. CHAIR WILSON reiterated that she is not saying that people do not need a break, but that perhaps a neighbor could come in and help out and it would not cost anything. MR. ASHMAN responded that the division is limiting respite to 10 hours per week or 520 hours per year. He said he believes that is fair and consistent with what other states have been providing. He agreed that there certainly should be respite [assistance]. MS. COTTING told the members that she has a copy of the draft plan for the next four years, which was obtained from the Department of Health and Social Services. Number 2018 REPRESENTATIVE WOLF replied that he would like a copy. He asked Mr. Ashman to elaborate on the regulations that are being proposed. MR. ASHMAN asked if he and one of his staff, who is very knowledgeable, could meet with him to discuss the regulations in detail. REPRESENTATIVE WOLF shared that this past summer his mother-in- law had a stroke, and said that he was surprised by the discouraging attitude his family encountered in choosing to care for her at home. He said this was a family stepping-up to care for her; it was not going to cost anyone anything. He asked Mr. Ashman to comment on that prevailing attitude. Number 2086 MR. ASHMAN commented that his response would be dangerous. He shared that his family recently did the same thing. His father passed away in his own home, he said. When his wife's mother was dying, during the last six months of her life his wife cared for her for four months. He said he believes that it is the way a person is raised, more than anything else. Mr. Ashman said that is where personal beliefs come in. He said he could not say why [Representative Wolf's family was discouraged from caring for his mother-in-law]. He reiterated that he believes it is how a person is raised. REPRESENTATIVE WOLF shared that his mother-in-law taught school for 36 years in California. She's 74 years old now and upset that this is happening to her. He said it took a while for him to convince her that she is on the biggest teaching assignment that she ever encountered, because now she's teaching her kids compassion. It is a very valuable lesson. Number 2168 MARIE DARLIN, Coordinator, Capital City Task Force, AARP Alaska, testified in support of HB 374. She told the members that AARP Alaska fully supports the continuation of the Commission on Aging. Over the years AARP Alaska has worked with the commission on may issues and looks to them, and hopes to continue to look to them, as a group that will be working with organizations such as AARP to ensure that there is a plan that will meet the needs of communities. Ms. Darlin explained that currently AARP Alaska is one of the groups the commission works with in determining what the needs are. Many of the issues that have been discussed today are concerns of AARP Alaska as well. She added that she served on the Juneau Commission on Aging for about six years, and said that it is important for the state commission to go to the local commissions on aging when determining the needs of the community. Some communities do not have a local commission, but most communities are interested in having one, she added. Number 2255 REPRESENTATIVE COGHILL commented that he believes every member should attend at least one commission debate. Number 2263 REPRESENTATIVE CISSNA moved to report CS HB 394, 23-LS1534\D, Mischel, 2/19/04, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, CS HB 394(HES) was reported out of the House Health, Education and Social Services Standing Committee.