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ARIZONA STATE LEGISLATURE
Forty-eighth Legislature – Second Regular Session
IN-HOME CARE PROVIDERS STUDY COMMITTEE
Minutes of Meeting
Chairman Aguirre called the meeting to order at 10:34 a.m. and attendance was noted by the secretary.
Senator Amanda Aguirre, CoChair Kathleen Collins-Pagels
Representative Nancy Barto, CoChair Dawn DeMers
Representative Chad Campbell Alan Oppenheim
Karen Barno Dr. Gail Silverstein
Members Absent
Senator Tom O’Halleran Guy Mikkelsen
Victor McMurry Virginia Pottenger
Speaker Present
Dan Brown, House Research Analyst, Health Committee
OPENING REMARKS AND INTRODUCTION OF COMMITTEE MEMBERS:
CoChair Aguirre stated that different opinions have been expressed as to license certification and who the person should be to take care of loved ones.
CoChair Aguirre asked members to introduce themselves.
Ms. Collins-Pagels offered her concern that the Committee move carefully and cautiously through this process. She expressed the need to continue to hear from stakeholders who have been discussing this issue in their own businesses and communities.
Dr. Silverstein concurred. She said her concern is that there are still a lot of different opinions out there and said she hesitates to rush into something that everyone has to live with later on.
CoChair Aguirre advised that, by law, this Committee is dissolved at the end of September. Because of the time constraint, she believes Committee recommendations will have to be very general and said it is important that the Committee not rush to any decisions. She said this is an industry that needs to be very carefully looked at to ensure that patients and families at home are not being taken advantage of by some health workers.
STAFF PRESENTATION ON CHARGE OF COMMITTEE:
Dan Brown, House Research Analyst, Health Committee, reviewed the charge of the Committee:
Mr. Brown related that he received recommendations from three Committee members (Attachments 1, 2 and 3) and pointed out that he wrote notes on document #2 to make it clear where certain recommendations were suggested.
COMMITTEE MEMBERS’ INPUT AND DISCUSSION OF RECOMMENDATIONS:
Ms. Collins-Pagels stated that the fundamental question that has been raised is whether to license the agency or certify the individual. She pointed out that these are two very different actions and suggested that the two paths be looked at, as well as the costs and the different requirements.
Ms. DeMers agreed. She believes oversight has to be decided initially, whether it be the agencies or the individuals.
Representative Campbell said he agrees with that assessment; however, he would like to proceed with the recommendations first and not be limited to the oversight body. He stated that money will be a deciding factor.
CoChair Aguirre commented that the level of reimbursement for workers and agencies is an issue that has not been addressed.
Ms. Collins-Pagels concurred that cost must be considered. She said that nursing homes and assisted living centers are often victims of unfunded mandates. She thinks it would be wise to look at the least-possible incremental stages in this budget climate; otherwise members’ ideas will be dismissed.
Dr. Silverstein expressed concern about rushing into recommendations. She believes a good starting point would be SB 1605, in-home personal care services agencies, submitted in 2007. The provisions of that bill were reviewed by many people. The national model by the National Private Duty Association was used to develop those requirements, looking at what other states were doing. She reviewed her recommendations (Attachment 3).
In response to CoChair Aguirre, Dr. Silverstein answered that about half of the states do license non-medical home care. She noted there are many variations of the model across the country, and noted that the agency, not the individual, gets the license.
CoChair Barto expressed concern about moving in that direction without having some data on the results of adopting that model.
Ms. Collins-Pagels asked whether the national organization has any data available from other states. Dr. Silverstein said she will check on that.
CoChair Aguirre wondered about the level of training for different levels of care. Dr. Silverstein replied that every agency is different in how they handle training. She related that the Arizona Health Care Cost Containment System (AHCCCS) specifies what topics have to be covered by the Arizona Long Term Care System (ALTCS) providers to ensure that training is carried out properly.
In reply to CoChair Aguirre’s request to comment on the Governor’s Task Force, Ms. Collins-Pagels advised that the Governor appointed the Direct Care Workforce work group in 2005. That group came up with 10 recommendations, with training the big issue for direct care workers. Since that time a number of other recommendations have been implemented (Attachment 4). She commended the home care profession for voluntarily adopting the Direct Care Workforce curriculum.
CoChair Aguirre said she understands some community colleges have implemented that curriculum. Ms. Collins-Pagels concurred. She asked that Jutta Ulrich from the Department of Economic Security be requested to testify before this Committee on existing training standards, implementation by community colleges and voluntary participation with the agencies. She said considerable discussion at the AHCCCS level has taken place about whether this will be required contractually. She reiterated that cost for the providers must be considered.
CoChair Aguirre agreed that discussions with AHCCCS should take place on whether there will be reimbursement for this care, once caregivers are certified or licensed, and at what level of reimbursement.
Ms. DeMers advised that discussions have taken place but they have not gotten a specific answer other than the issue is being reviewed. She said her only concern with this is that agencies are already being reviewed by AHCCCS, and the issue is those agencies that only provide private care.
Ms. Collins-Pagels pointed out that it is voluntary regulation.
Representative Campbell referred to the Mikkelson letter and said he thinks that licensure and training have to be looked at, and again cautioned about costs. He advised that he is leaning more towards a fee-based system. He brought up the stringent requirements of the Board of Cosmetology compared to the lax industry requirements.
CoChair Aguirre reiterated that since the Committee dissolves on September 30, 2008, an option is to request that the Senate President and House Speaker appoint an ad hoc committee or a task force consisting of the members of this committee to continue to work on this issue.
In response to Ms. Collins-Pagels, Mr. Brown explained that an ad hoc committee and study committee are virtually identical and there is not a lot of difference in terms of how the committee will function.
Representative Campbell advised that he intends to introduce legislation again next session on this issue, using Senator O’Halleran’s 2007 legislation as a starting point.
Ms. Barno advised that the biggest issue that needs to be examined is training.
Discussion ensued on the programs being offered at community colleges.
Ms. Collins-Pagels stated that consideration needs to be given to the State’s role in setting minimum standards
Mr. Oppenheim spoke of the need to look at regulating the agency or the individual, and to what depth.
Representative Campbell moved that the In-Home Care Providers Study Committee recommend to the Speaker of the House and the Senate President that an ad hoc committee be created to further study the charge of this Committee. The motion carried.
Representative Campbell expressed hope that the next meeting will be convened as quickly as possible to try to figure out the nuances of this issue.
Without objection, the meeting adjourned at 11:20 a.m.
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Joanne Bell, Committee Secretary
July 6, 2016
(Original minutes, attachments and audio on file in the Chief Clerk’s Office; video archives available at http://www.azleg.gov)
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IN-HOME CARE PROVIDERS STUDY COMMITTEE
2
September 24, 2008
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