Legislature(2009 - 2010)BUTROVICH 205

02/04/2009 01:30 PM HEALTH & SOCIAL SERVICES


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01:32:42 PM Start
01:37:52 PM SB32
02:21:12 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 32 MEDICAID:HOME/COMMUNITY BASED SERVICES TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
         SB  32-MEDICAID:HOME/COMMUNITY BASED SERVICES                                                                      
                                                                                                                                
CHAIR DAVIS announced consideration of SB 32.                                                                                   
                                                                                                                                
SENATOR  ELLIS thanked  the  committee for  hearing  this bill  so                                                              
promptly  and for  the co-sponsorship  of several  members of  the                                                              
committee.  He said  this bill  provides for  regular rate  review                                                              
for  home and  community-based services.  These are  the home  and                                                              
community-based  services that  help Alaska  seniors and  Alaskans                                                              
with developmental  disabilities;  he was  pleased to report  that                                                              
letters  of  support  have  been  coming  into  his  offices  from                                                              
providers  across the  state. This  is  a topic  of keen  interest                                                              
because it  affects the  quality of life  for Alaskan  seniors and                                                              
those  with  developmental  disabilities   and  because  for  many                                                              
community-based  services it is  a matter  of staying  in business                                                              
or going out of business.                                                                                                       
                                                                                                                                
He said  that when  he was approached  last fall about  sponsoring                                                              
this legislation,  he researched the  statutes and realized  it is                                                              
absolutely  appropriate  that  statute   calls  for  regular  rate                                                              
reviews for hospitals  and nursing homes, which do  a terrific job                                                              
caring for Alaskans.  The state has also made a  policy and budget                                                              
decision  to  license  and  encourage   home  and  community-based                                                              
services offering  a lower level of  care to keep Alaskans  out of                                                              
those more  expensive and restrictive  settings. There is  a place                                                              
for  all  of  the for-profit  and  non-profit  businesses  in  the                                                              
continuum  of care  across Alaska;  so when people  asked  him why                                                              
hospitals  and   nursing  homes  have  regular  rate   review  and                                                              
consideration for covering  the true cost of care,  while home and                                                              
community  services   do  not,  he  could  not   give  a  rational                                                              
response.  The time  has  come for  this  legislature to  consider                                                              
regular, if  not annual, rate review  for the home  and community-                                                              
based services.                                                                                                                 
                                                                                                                                
SENATOR  ELLIS met  with Commissioner  Bill  Hogan, Department  of                                                              
Health  and  Social  Services  (DHSS)  and  members  of  his  team                                                              
yesterday;  they  have decided  to  work collaboratively  to  find                                                              
common  ground on  this  issue. He  added that  he  would like  to                                                              
offer  some   recommendations  and  refined  language   that  were                                                              
developed through  that collaboration at  a future meeting  in the                                                              
form  of   a  proposed  committee   substitute,  but   wanted  the                                                              
committee to hear some important testimony today.                                                                               
                                                                                                                                
1:37:52 PM                                                                                                                    
MAX  HENSLEY,  staff to  Senator  Ellis,  said that  because  they                                                              
anticipate some  technical changes to  the bill going  forward, he                                                              
would speak broadly to the intent of the bill at this time.                                                                     
                                                                                                                                
CHAIR  DAVIS  interjected  that  she would  like  Mr.  Hensley  to                                                              
present the  sponsor's statement  for people  in the audience  who                                                              
are not familiar with the bill.                                                                                                 
                                                                                                                                
MR.  HENSLEY  explained  that  SB   32  creates  a  mechanism  for                                                              
providers  of   home  and  community-based  services   to  receive                                                              
regular  rate  reviews.  Providers  of  home  and  community-based                                                              
services do  so through  four Medicaid waivers  that the  state of                                                              
Alaska currently  holds,  which allow them  to seek  reimbursement                                                              
on  a 50/50  state/federal  match. Those  four  waivers cover  the                                                              
categories  of  older  Alaskans,   the  developmentally  disabled,                                                              
children  with   complex  medical   conditions  and   adults  with                                                              
physical  disabilities.  There  are  approximately  350  providers                                                              
serving 6400  people across state  under these waivers.  This does                                                              
not  include  the  845  people   who  were  on  the  developmental                                                              
disabilities wait list at the close of fiscal year 2008.                                                                        
                                                                                                                                
The rates  these providers  receive were  frozen for years,  until                                                              
the legislature  gave them  a four percent  rate boost  across the                                                              
board  in 2008. Many  of them  have not  received a  comprehensive                                                              
rate review  since 2004  and some  have not had  a review  in more                                                              
than a  decade, which  means their  reimbursement rates  are based                                                              
on an antiquated  methodology that does not reflect  modern prices                                                              
and  practices.  These services  are  key  to allowing  people  to                                                              
continue to  live their  lives in  their communities among  family                                                              
and friends, holding jobs as productive members of society.                                                                     
                                                                                                                                
He highlighted  a few  of the many  associations around  the state                                                              
that  have  provided  letters  in  support  of  this  legislation,                                                              
including:  AARP,  The  Commission  on Aging,  The  Mental  Health                                                              
Board, The  Advisory Board on Alcohol  and Drug Abuse,  The Mental                                                              
Health Trust Authority,  the AgeNet coalition of  health providers                                                              
and Alaska Behavioral Health Association.                                                                                       
                                                                                                                                
1:41:02 PM                                                                                                                    
MR. HENSLEY added  that there are three sections in  the bill; all                                                              
three  add  the  words  "home  and  community  based  services  as                                                              
defined  in  the Medicaid  waivers  section  of statutes"  to  the                                                              
current rate  review section, which  applies to the  institutional                                                              
services.                                                                                                                       
                                                                                                                                
CHAIR DAVIS announced  that she will take public  testimony before                                                              
entertaining questions.                                                                                                         
                                                                                                                                
1:41:41 PM                                                                                                                    
MARIE  DARLIN, AARP  Capital  City Task  Force,  Juneau, AK,  said                                                              
AARP strongly  supports this  bill. These  community services  are                                                              
very  important  to  all  the  members  of  AARP;  with  an  aging                                                              
population,  it  is important  that  these providers  be  properly                                                              
paid so they can  continue to provide the services  needed to keep                                                              
people out  of more  costly facilities.  She reminded  the members                                                              
that this  also affects younger  people who have  disabilities and                                                              
who,  with these  services, may  be  given the  opportunity to  be                                                              
part of their communities.                                                                                                      
                                                                                                                                
It makes  sense, she  concluded, to review  these rates  yearly as                                                              
they do for hospitals;  it might actually result in  more home and                                                              
community-based  services,   which  are  desperately   needed  and                                                              
represent a less-costly way to do business.                                                                                     
                                                                                                                                
1:44:20 PM                                                                                                                    
LYNN  KENNEY,  Alaska Association  on  Developmental  Disabilities                                                              
(AADD),  Wasilla, AK,  said AADD  is  an organization  of over  30                                                              
disabilities   service  providers   statewide  including   Bethel,                                                              
Kotzebue,   Nome,   Seward,  Homer,   Soldotna,   Valdez,   Sitka,                                                              
Ketchikan,  Anchorage,   Juneau  and  Fairbanks.   It  was  formed                                                              
approximately 28 years  ago to create a united  provider voice for                                                              
best  practices,  advocacy,  partnership  and networking  and  was                                                              
spearheaded by  the Fairbanks Resource  Agency, Hope  Cottages and                                                              
ARCA [American  Rehabilitation Counseling Association];  that idea                                                              
evolved  into  AADD.  AADD  member   organizations  share  similar                                                              
concerns,   experience  similar   problems  and   have  a   unique                                                              
perspective  as  providers  of  services.  Today  AADD  remains  a                                                              
united body that  volunteers time, effort, expertise  and a belief                                                              
in  what people  working together  can  accomplish. AADD  strongly                                                              
supports SB 32  and appreciates this legislation  being introduced                                                              
by Senator Ellis and co-sponsored by the Chair.                                                                                 
                                                                                                                                
AADD  Member organizations  have  been struggling  to continue  to                                                              
provide the  same level  of services with  rates that  were frozen                                                              
in 2004.  Last year  the legislature did  grant a modest  increase                                                              
in rates,  but there is  no increment in  this year's  budget, nor                                                              
is  there  a  mechanism  in  place  for  rates  to  keep  up  with                                                              
inflation  and cost  of  living  increases. Providers  are  deeply                                                              
concerned  about how  they can  continue  to offer  the best  care                                                              
possible. How,  she asked,  can they  keep quality personnel  with                                                              
no  pay increases,  shrinking  benefits  and extended  work  days?                                                              
They are  losing many  good employees who  aren't leaving  to work                                                              
for another provider but are leaving the field all together.                                                                    
                                                                                                                                
MS. KENNEY urged the committee to support SB 32.                                                                                
                                                                                                                                
1:47:55 PM                                                                                                                    
JOHN CANNON, Executive  Director, Matsu Services  for Children and                                                              
Adults, Wasilla,  AK, said he agrees with the  previous testimony.                                                              
He thanked the  committee for their consideration of  the bill and                                                              
expressed his  strong support.  His agency  serves over  300 MatSu                                                              
residents  with  disabilities and  this  would make  a  tremendous                                                              
difference in their  lives; it will give the  agency the stability                                                              
it  needs, with  rates  they can  rely on  and  a more  dependable                                                              
pricing structure.                                                                                                              
                                                                                                                                
1:49:12 PM                                                                                                                    
MIKE  RACE, past  president  of  Pioneers of  Alaska  and head  of                                                              
their   legislative   committee,   Juneau,   AK,   expressed   his                                                              
appreciation for  the opportunity  to speak before  the committee.                                                              
Pioneers of  Alaska is  very supportive  of this legislation;  the                                                              
quality  of  care that  people  can  bring  into their  homes  for                                                              
themselves  and their families  is critical  to their  members, he                                                              
said, and  the intent  of this legislation  is superb.  He thanked                                                              
the  committee again  and  said  the Pioneers  of  Alaska will  be                                                              
looking forward to further action.                                                                                              
                                                                                                                                
1:50:39 PM                                                                                                                    
JOHN  SHERWOOD, [Medical  Assistant  Administrator] Department  of                                                              
Health and  Social Services (DHSS),  Juneau, AK, agreed  that this                                                              
is  a very  important subject.  He  said the  department has  been                                                              
working with  a contractor  for about a  year to develop  new rate                                                              
methodologies for  paying providers and appreciates  Senator Ellis                                                              
addressing   it  in   this   legislation.   The  department   also                                                              
appreciates  the  increase  they   were  able  to  give  providers                                                              
through the  budget last  year. They do  have some concerns  about                                                              
specific provisions  of the bill and look forward  to working with                                                              
both Senator  Ellis  and the committee  to come  up with  language                                                              
that will be acceptable to all.                                                                                                 
                                                                                                                                
1:52:08 PM                                                                                                                    
SENATOR  DYSON   asked  if  he   understood  correctly   that  the                                                              
department has  been looking  at the adequacy  of these  rates for                                                              
about a year.                                                                                                                   
                                                                                                                                
MR. SHERWOOD  confirmed that  the department  has been  looking at                                                              
the  rates; they  surveyed providers  during the  late summer  and                                                              
fall  of 2008  to get  cost information  and see  how it  compares                                                              
with current  rates.  One of the  things they  discovered  is that                                                              
the kind  of cost accounting the  department uses for  rates isn't                                                              
the  same   as  the  accounting   many  of  these   providers  do.                                                              
Consequently  they  could not  get  as  much information  as  they                                                              
wanted, but  to the extent  they could  find it, it  appeared that                                                              
costs were  about equal to  rates with variations  among different                                                              
types  of  services. Of  course,  he  said,  to some  extent  that                                                              
reflects the  fact that the  State is the  primary payer  for most                                                              
of these services;  people can only spend the amount  of money the                                                              
state  pays them  to provide  a service,  so there  is a  circular                                                              
nature to the calculation.                                                                                                      
                                                                                                                                
SENATOR  DYSON  asked  if  he is  correct  in  assuming  that  the                                                              
department  does not  need  this bill  to perform  a  study or  to                                                              
adjust rates.                                                                                                                   
                                                                                                                                
MR. SHERWOOD  agreed that  they do  have the regulatory  authority                                                              
to set rates or establish a rate methodology.                                                                                   
                                                                                                                                
SENATOR DYSON asked  what the department wants to  see adjusted in                                                              
this legislation;  what is the  department uncomfortable  about in                                                              
it or in the direction that Senator Ellis is headed with it.                                                                    
                                                                                                                                
1:54:40 PM                                                                                                                    
MR.  SHERWOOD  responded  that  the department  has  a  couple  of                                                              
concerns with  it; one is  placing the rate-setting  provision for                                                              
these  providers in  the  same statute  they  use  for the  health                                                              
facilities.  There is a  history to  that health facility  statute                                                              
that goes  back to a  period of time  when the federal  government                                                              
dictated  a very specific  way the  state had  to establish  rates                                                              
for those  facilities and  the statute was  intended to  bring the                                                              
state  into compliance  with  the federal  statute.  For the  most                                                              
part, the  explicit methodologies  for setting provider  rates are                                                              
not  set in  statute  as it  deprives the  state  of one  possible                                                              
option when it  needs to look at cost-containment  strategies. The                                                              
department is  willing to look  at language that  establishes some                                                              
parameters about  how they will  develop rates and  how frequently                                                              
they will be reviewed.                                                                                                          
                                                                                                                                
SENATOR DYSON asked  Mr. Sherwood if he is correct  in saying that                                                              
the department  believes methodology  is better set  in regulation                                                              
rather than in statute.                                                                                                         
                                                                                                                                
MR. SHERWOOD  confirmed that  is the  long-standing preference  of                                                              
the department.                                                                                                                 
                                                                                                                                
SENATOR  DYSON   agreed  with  Senator   Ellis  that  it   is  the                                                              
legislature's  responsibility to  make sure  there are  sufficient                                                              
resources  available  to protect  the  well-being  of the  state's                                                              
vulnerable population.  Before this process  is over, he  said, he                                                              
would  like someone  from  the department  to  tell the  committee                                                              
whether or not there  are sufficient funds in the  rate to provide                                                              
this vulnerable population the quality of help they need.                                                                       
                                                                                                                                
1:57:33 PM                                                                                                                    
MR. SHERWOOD  said he  thinks they  can come  to a decision  about                                                              
whether a  methodology is adequate  to provide good  rate-setting.                                                              
They still  have a lot to  learn about provider costs  however, so                                                              
he cannot  make a  definitive statement  that  where they  will be                                                              
tomorrow is exactly where they should be.                                                                                       
                                                                                                                                
1:58:35 PM                                                                                                                    
SENATOR DYSON  asked Mr.  Sherwood if  it is  true that  the state                                                              
does not  have an  ombudsman monitoring  the  care of these  folks                                                              
and  that no  audit  has  been performed.  He  said  he thinks  he                                                              
understands  Mr. Sherwood's  and the  department's position;  they                                                              
are  worried  that  the  legislature   will  put  into  statute  a                                                              
mechanism that  is going to drive  costs at a time when  the state                                                              
is  facing  a  $1.6  billion  deficit  and  he  appreciates  their                                                              
concern.  If indeed  these clients  are not getting  the level  of                                                              
care they need  however, that would indicate that  the methodology                                                              
the state  uses for  setting the  costs is  missing something;  or                                                              
the methodology  isn't being applied;  or if it is  being applied,                                                              
the state is not appropriating the money.                                                                                       
                                                                                                                                
MR. SHERWOOD  agreed that cost and  rate of payment  are certainly                                                              
important  considerations  in the  quality of  care,  but not  the                                                              
only  considerations  that  might   affect  quality.  He  believes                                                              
Alaska is  fortunate to have  many dedicated providers  who strive                                                              
to provide  quality services in  difficult circumstances.  He also                                                              
mentioned that  there is a  long-term care ombudsman  who oversees                                                              
the quality  of some, but not all  of the providers that  would be                                                              
affected by this bill.                                                                                                          
                                                                                                                                
SENATOR DYSON said  he appreciates that the department  is working                                                              
with  Senator  Ellis  to  improve  the  bill.  He  encouraged  Mr.                                                              
Sherwood to  fight for what he  believes is the  right methodology                                                              
and hoped  be would soon  be able to  state definitively  that the                                                              
administration  either  recommends   this  to  go  forward  or  it                                                              
doesn't.                                                                                                                        
                                                                                                                                
2:01:19 PM                                                                                                                    
CHAIR  DAVIS  pointed out  that  this  is  the Health  and  Social                                                              
Services Committee  and they won't  be dealing with  the financial                                                              
issues; Finance will take that up.                                                                                              
                                                                                                                                
She  advised Mr.  Sherwood  that while  she  appreciates the  fact                                                              
that he  has been working with  Senator Ellis's office,  this bill                                                              
is now  in her  possession because  she chairs  the HSS  committee                                                              
and she  expects to  hear about anything  the department  is doing                                                              
and any  concerns they have before  he comes before  the committee                                                              
to testify.  She said it  sounds as if  the department  is working                                                              
with Senator Ellis  to reach a compromise and  draft another bill,                                                              
but it  is up  to the  legislature to  decide if  it should  be in                                                              
policy,  regulation  or  statute.  She  asserted  that  she  isn't                                                              
trying to pin  him down, but she  does not want to be  left out of                                                              
the loop.                                                                                                                       
                                                                                                                                
2:03:11 PM                                                                                                                    
SENATOR DYSON  responded  to Chair Davis's  comments, saying  that                                                              
one of  the limitations  the Alaska legislature  has to  deal with                                                              
is that they are  not able to change regulation  by resolution, as                                                              
they are  in many  states. That  often leaves  the legislature  in                                                              
the position  of using  the heavy  hammer of  statute in  order to                                                              
force  changes in  regulations  they  believe are  inadequate.  He                                                              
agreed with  Senator Davis that  it is the  job of the  Health and                                                              
Social Services  Committee to  look after  the care that  Alaska's                                                              
citizens are  getting and said  he hopes the  two of them  will go                                                              
to  battle with  Finance if  necessary to  get the  funding to  do                                                              
what is needed.                                                                                                                 
                                                                                                                                
CHAIR DAVIS said  she has no problem with that; she  just wants to                                                              
point out that their  focus now is not on the finances  but on the                                                              
bill before  them. The Finance Committee  will have the  chance to                                                              
figure out  where the money is  coming from. Meanwhile,  she wants                                                              
to keep her focus on the mission of this committee.                                                                             
                                                                                                                                
SENATOR  ELLIS thanked  Mr.  Sherwood  for his  communication  and                                                              
collaboration. He  asked if it is  fair to say that the  number of                                                              
times  over the last  20 years  that the  department has  reviewed                                                              
and  increased  rates  through the  regulatory  process  has  been                                                              
infrequent.                                                                                                                     
                                                                                                                                
MR. SHERWOOD answered  that some of these rates  have been changed                                                              
infrequently; prior  to 2004, some of the rates  were reviewed and                                                              
adjusted  annually based  on budgeted cost  information but  since                                                              
that time very little analysis has been done.                                                                                   
                                                                                                                                
2:05:37 PM                                                                                                                    
SENATOR  ELLIS asked  if he  could speak  briefly to  some of  the                                                              
shortcomings  of  the  questionnaire   that  was  created  by  the                                                              
department's  contractor and what  they might  do to improve  upon                                                              
that. It  was described to  him by many  of the service  providers                                                              
as  a  complicated  questionnaire   and  he  understands  that  it                                                              
received a rather poor response.                                                                                                
                                                                                                                                
MR. SHERWOOD said  their contractor put out a survey  in line with                                                              
common cost  accounting surveys  used to  set rates for  different                                                              
sorts  of providers  in other  states.  The department  discovered                                                              
that most  of Alaska's providers,  having never done that  kind of                                                              
cost  accounting, did  not have  accounting systems  that made  it                                                              
easy  to accurately  determine  what  information  they needed  to                                                              
enter.  Even some  of the  providers whose  systems could  provide                                                              
the  information  said they  didn't  feel  they could  verify  its                                                              
accuracy;  so  they  chose  not   to  include  it.  In  subsequent                                                              
meetings  with   providers,  many  of   them  said  that   if  the                                                              
department could  give them a  standard for reporting  in advance,                                                              
they would be  willing to amend their accounting  systems in order                                                              
to respond.                                                                                                                     
                                                                                                                                
SENATOR DYSON left the meeting at 2:07 p.m.                                                                                     
                                                                                                                                
SENATOR  ELLIS  affirmed that  there  is  more  work to  be  done.                                                              
Finally, he  said, it is not  his intent to materially  affect the                                                              
annual rate  review for hospitals  and nursing homes.  He believes                                                              
it should be  relatively easy for the drafter  to compartmentalize                                                              
what he  is trying  to do with  this legislation  in a  portion of                                                              
the statute  that will have  no affect  on the long  legal history                                                              
of hospital  and nursing home rate  setting. He is just  trying to                                                              
ensure   the   same   less   restrictive,    more   cost-effective                                                              
consideration for home and community-based services.                                                                            
                                                                                                                                
2:08:48 PM                                                                                                                    
CHAIR  DAVIS thanked  Mr. Sherwood  for his  testimony and  agreed                                                              
that  there  is more  work  to be  done  on  this bill.  She  then                                                              
announced that she would open the floor to public testimony.                                                                    
                                                                                                                                
2:09:04 PM                                                                                                                    
STEVE LESKO,  President, State Board  of Directors,  Key Coalition                                                              
of  Alaska, Anchorage,  AK,  stated that  in  terms of  historical                                                              
significance and  importance, this is the most  critical testimony                                                              
he's  given  in over  30  years.  Decades  ago, a  reporter  named                                                              
Geraldo Rivera  exposed the  horrors, atrocities, segregation  and                                                              
brutalization  of those who  lived in  a now infamous  institution                                                              
called "Willowbrook."  This  past December,  he asserted  that the                                                              
wait  list  is,  in  essence,  the  new  institution,  calling  it                                                              
"imprisoning," producing  tremendous stress and strain.  Alaska by                                                              
and   through   the   fiscal   accountability   and   programmatic                                                              
compassion of this  legislature and administration  has instituted                                                              
a concerted  plan to  eradicate  its wait list  by implementing  a                                                              
draw  of   over  50  eligible   individuals  each   quarter;  only                                                              
yesterday that list  held captive over 1300 of  Alaska's families.                                                              
Today  that number  has been  reduced to  845. There  is just  one                                                              
significant problem;  Alaska's community programs and  the lack of                                                              
a  rate-review  process.  Due  to  this  systematic  operation  to                                                              
eradicate the waiting,  the "patient," the community  programs and                                                              
all  the Alaskan  families they  support,  is dying.  Many of  the                                                              
symptoms have  been reported: a  significant inability  to recruit                                                              
and retain qualified  staff; cuts in benefits that  include health                                                              
insurance;  dramatic  increases   in  co-pay  and  deductibles;  a                                                              
sporadic  inability to  consistently  and  effectively train  many                                                              
staff that  results in a chronic  lack of service and  a revolving                                                              
door of staff  turn over and the  reality that many staff  need to                                                              
maintain two  jobs, to come  to work when  sick to  fill vacancies                                                              
or to  work unhealthy double  shifts ... 16  or more hours  on the                                                              
job per  day. Programs have  cut, reduced and eliminated,  begged,                                                              
borrowed,   maintained  lines   of  credit   and  have   stretched                                                              
themselves  so precariously  thin that  they are  now in a  danger                                                              
zone where something must and something will have to give.                                                                      
                                                                                                                                
MR. LESKO  continued, stressing that  everyone should be  aware of                                                              
the  escalating  list  of  expenses   they  face  every  day  from                                                              
gasoline prices,  to heating costs,  goods and products,  rentals,                                                              
transportation  and  insurance.  Last year  [home  and  community-                                                              
based  services] saw  a four  percent increase  after a  four-plus                                                              
year rate freeze;  factored over a period of  six years, community                                                              
programs  will have  received  2/3 of  one  percent annually!  The                                                              
commercial   sector  would   increase  the   price  of   products,                                                              
institute  layoffs or  simply  shut their  doors;  these home  and                                                              
community-based service  providers can do neither,  nor would they                                                              
choose to  do so. Theirs is  a labor-intensive profession  and the                                                              
challenges   to  secure   an   adequate  workforce   are   growing                                                              
astronomically.   The  health   and   safety   of  Alaska's   most                                                              
vulnerable citizens  is their paramount  concern; this is  why the                                                              
Key Coalition  of Alaska  embraces and  unequivocally supports  SB
32 as  a desperately  needed solution  to the rapid  deterioration                                                              
of the community support network.                                                                                               
                                                                                                                                
He  urged  the  committee  to begin  forging  a  legacy  built  on                                                              
equity, parity and a true sense of community preservation.                                                                      
                                                                                                                                
2:13:43 PM                                                                                                                    
CHAIR DAVIS  advised the  committee that  Jack Nielson,  Executive                                                              
Director,  Department of  Health and  Social Services,  Anchorage,                                                              
AK, and  Emily Ennis,  Fairbanks Resource  Agency, Fairbanks,  AK,                                                              
are on line and available for questions if needed.                                                                              
                                                                                                                                
CHAIR  DAVIS closed  public  testimony and  announced  that SB  32                                                              
will not be  moved today; she asked  the sponsor if he  would like                                                              
to make a closing statement.                                                                                                    
                                                                                                                                
2:14:52 PM                                                                                                                    
SENATOR ELLIS  said there is more  work to be done; he  intends to                                                              
bring a  set of choices  before the  committee for discussion  and                                                              
perhaps a  committee substitute  for their  consideration.  Out of                                                              
respect for  the committee's  time he said,  he did  not encourage                                                              
everyone  to testify,  although  there were  people  all over  the                                                              
state  "chomping  at  the bit"  to  do  so.  His office  has  been                                                              
soliciting letters  of support and  resolutions from all  over the                                                              
state and those continue to pour in.                                                                                            
                                                                                                                                
Many of  Alaska's home and  community-based services  have reached                                                              
a breaking  point. As Steve Lesko  said so eloquently,  they can't                                                              
lay off workers;  they can't close their doors or  people would be                                                              
out in the  streets; the time has  come to have some  regular rate                                                              
review so  they can  keep up with  reality and  the cost  of doing                                                              
business.  These providers,  the vulnerable  children and  adults,                                                              
are looking to the legislature to make the right decision.                                                                      
                                                                                                                                
2:16:49 PM                                                                                                                    
JIM  BECK,  Executive  Director,  Access  Alaska,  Anchorage,  AK,                                                              
spoke as an advocate  for the rights of persons  with disabilities                                                              
and elder  Alaskans and  as a provider  of Medicaid  personal care                                                              
assistance.  He said  much of his  testimony  has been covered  by                                                              
others, but  he wants to  make two points.  He wants to  make sure                                                              
that personal  care assistant services  are included in  the final                                                              
version  this  bill.  Personal   care  assistant  services  are  a                                                              
foundational  set  of  services  that  aren't  part  of  the  four                                                              
Medicaid  waivers Mr. Hensley  talked about.  These services  save                                                              
the  state  a  lot  of money  and  currently  serve  thousands  of                                                              
Alaskans  in their  homes. He  also emphasized  the importance  of                                                              
statutory  rate review.  It  is clear,  he  said, that  regulatory                                                              
authority  is not  enough or  personal  care would  not have  gone                                                              
over 10 years  without a rate increase. Starving  providers on the                                                              
most cost-effective  end of the long-term care  system is terribly                                                              
ineffective  public  policy;  home  and  community-based  services                                                              
must be  on an  equal footing with  expensive institutional  care.                                                              
He  pointed out  that  he has  not once  seen  the state  threaten                                                              
Providence  Hospital or any  of the  institutional care  providers                                                              
with rates  as a means  of cost-containment,  yet that  is exactly                                                              
the strategy  that has  been foisted  on home and  community-based                                                              
service agencies  for years.  It is Access  Alaska's hope  that SB
32 will  solve that problem  and put them  on a statutory  footing                                                              
and not  a regulatory  one. With  that, he  thanked the  committee                                                              
for  hearing  this   bill  and  said  he  would   provide  further                                                              
testimony in writing.                                                                                                           
                                                                                                                                
2:19:43 PM                                                                                                                    
SENATOR THOMAS said  that Mr. Beck's testimony is  along the lines                                                              
of  his  own   concerns.  He  is  not  intimately   familiar  with                                                              
47.07.070  or with  the definition  of  "home and  community-based                                                              
services"   under  the   Act;  so   he  is  curious   as   to  how                                                              
comprehensive this  is and what other services they  might they be                                                              
missing.  He  said they  should  be  looking  to make  sure  those                                                              
ancillary services are at least considered.                                                                                     
                                                                                                                                
SENATOR ELLIS said his office can get that information.                                                                         
                                                                                                                                
2:20:42 PM                                                                                                                    
CHAIR  DAVIS reiterated  that many  people  have provided  written                                                              
testimony;  they couldn't  possibly have  accommodated all  of the                                                              
people who  wanted to speak. She  repeated that this bill  will be                                                              
coming back at a later time. [SB 32 was held in committee.]                                                                     
                                                                                                                                

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