---------- DOCUMENT HEADER ----------
---------- DOCUMENT HEADER ----------
ARIZONA STATE LEGISLATURE
Forty-eighth Legislature – First Regular Session
IN-HOME CARE PROVIDERS STUDY COMMITTEE
Minutes of Interim Meeting
House Hearing Room 3 – 2:00 P.M.
Chairman Barto called the meeting to order at 2:02 p.m. and attendance was noted by the secretary.
|
Senator Amanda Aguirre, CoChair |
Representative Nancy Barto, CoChair |
|
Senator Tom O'Halleran |
Representative Chad Campbell |
|
Karen Barno |
Virginia Pottenger |
|
Kathleen Collins-Pagels |
Dr. Gail Silverstein |
|
Dawn DeMers |
Lisa Wynn |
|
Guy Mikkelsen |
|
|
none |
|
Opening Remarks
Chairman Barto welcomed the group and asked each member to introduce him or herself:
Karen Barno, Arizona Assisted Living
Lisa Wynn, Arizona Department of Health Services
Guy Mikkelsen, Foundation for Senior Living
Dawn DeMers, Homestead Senior Care
Kathleen Pagels, Arizona Health Care Association
Gail Silverstein, Corner Care Personal Care Services
Virginia Pottenger, Arc of Arizona
Chairman Barto informed the committee that the in-home care consumer member of the committee has not yet been appointed.
Presentations
Licensing Issues, Arizona Department of Health Services
Pete Wertheim, Arizona Department of Health Services (DHS), addressed the committee on the topic of licensing issues. He distributed a list of legislative issues considered for regulation of caregiver service agencies (Attachment 1):
Senator O’Halleran asked Mr. Wertheim to discuss the timelines which have been developed and asked for more detail about the personnel training and testing. Mr. Wertheim replied that the industry and consumers are best qualified to define the training and testing requirement.
Senator O’Halleran asked how the committee will proceed on that; Chairman Barto replied that a stakeholders’ meeting with the assistance of DHS would be helpful.
Senator Aguirre added that a separate committee meeting to review the recent bill that was passed would be a good idea.
Senator Aguirre inquired about enforcement; Mr. Wertheim replied that DHS does not regulate individuals, only facilities, agencies, and the industry.
Ms. Wynn added that licensed home health agencies and hospices would be the closest to a survey model, as they have structure and guidelines.
Representative Campbell asked about testing and training and licensure boards; Mr. Wertheim replied that the 90/10 model for a regulatory system, where an individual receives a license and then can be monitored, could be used and could be put under the jurisdiction of DHS, although, he added, that could be a daunting task.
Representative Campbell commented that this industry encompasses a broad range of services and any regulatory body must reflect this range. Senator Aguirre commented that the closest training would be that of a CNA (certified nursing assistant), but that the clinical skills may not be necessary.
Ms. Pagels urged the committee, as it evaluates the different models, to also look at the cost to the providers to provide training, which could result in fees up to $1,500. Mr. Wertheim added that Arizona fee system is low as the state subsidizes a fair amount of the enforcement.
Chairman Barto asked for more detail on the cost to run the surveys; Mr. Wertheim replied that the more features in the survey, the greater the cost, but that in the first year the cost would be $220 thousand and in the second year, $220 to $400 thousand when fully implemented with seven full-time employees.
Chairman Barto asked about fingerprinting requirements; Mr. Wertheim replied that this check might open up information that disqualifies, for instance, a husband who is providing home care to his ill wife.
Discussion ensued about fingerprinting and the appeal process. Ms. DeMers reminded the committee that there is no direct oversight when the caregiver is in the home. Senator O’Halleran commented that he has no objection to fingerprinting and proper background checks to ensure patient safety, but that there is a shortage of workers in this area. Representative Campbell concurred that these checks are essential for safety. Ms. Silverstein commented that the turnaround time of a check can be critical and that she does not want to send anyone into a home who has not passed such a check. Ms. Pagels stated that the agencies concur with background checks but that cost and timing to perform the checks must be considered. Discussion continued.
Ms. DeMers stated that now many different agencies come into her company to regulate different things and asked if DHS could provide one oversight and pull all these checks together; Mr. Wertheim replied that it is hard to say at this time. Senator O’Halleran stated the multiplicity of four federal and state agencies is a tremendous waste of money.
Alan Schafer, Arizona Long Term Care System (ALTCS), Arizona Health Care Cost Containment System (AHCCCS), distributed information about the ALTCS (Attachment 2) and explained that it serves people who largely live at home but who are at risk of institutionalization (due to either developmental disabilities or physical disabilities). He stated that ALTCS contracts with managed care organizations (MCO), which provide primarily in-home, non-skilled care; he added that skilled nursing care is typically provided by Medicare or home health agencies.
Chairman Barto asked where he is in the process of standardizing training issues; Mr. Schafer replied that development is underway and that he hopes, in the early spring of 2008, to take recommendations to the interagency council on long-term care. Ms. Pagels stated that there is a need for uniform requirements for caregivers’ training and hiring across these MCO contracts, even though the contracts may vary. Discussion ensued about the specificity of requirements for these MCOs. Mr. Schafer stated that the contracts are not too detailed in order to allow flexibility and variability with the various programs of the MCOs.
Chairman Barto reiterated that ALTCS will roll out a minimum standard for training in April of 2008; Mr. Schafer concurred, adding that the roll out will occur slowly to allow for grandfathering, family members hired through an agency, and such as that. He added that it will take two to three years to properly implement as ALTCS contracts for over one million hours of services per month and deals with hundreds of agencies.
Bob Roth, Cypress Homecare, discussed the importance of providing safe, non-medical home care, which enables an ill person to remain at home and provides support and peace of mind for family members. He stated his opposition to SB1605 and his support for this study committee. His company is an ALTCS provider and is an advocate for the rules and regulations being requested. He distributed a survey (Attachment 3) which represents a coalition of agencies which are on both sides of SB1605. He stated that caregiver shortage is the biggest issue facing the industry today.
Chairman Barto asked when the results of his survey will be known; Mr. Roth replied that the results should be out next week, but that they would not be in the form of a recommendation.
Marc Katz, Hearts of Joy Senior Care, identified himself as a caregiver and stated his opposition to SB1605 because he was not involved in the development of the legislation. He explained that he did favor HB2587 to form this study committee with members of the general populace. He stated his preference for less oversight and more guidelines, and stated that most agencies cannot afford to conduct the training that regulation would require. He distributed a document of statistics on home care (Attachment 4).
Representative Campbell stated that this is a complicated issue and that, because of the wide range of issues and services in the industry, he believes that it exceeds the scope of DHS to regulate.
Public Testimony
There was no one registered to speak.
Discussion of Future Agenda Items
Senator Aguirre stated that the committee will continue to bring stakeholders forward to testify. She stated that she is not inclined to over-regulate an industry which has a shortage of care-givers.
Chairman Barto stated that the committee is at the beginning of the process which will address this very complex issue.
Without objection, the meeting adjourned at 3:54 p.m.
___________________________________
Jane Dooley, Committee Secretary
December 5, 2007
(Original minutes, attachments and audio on file in the Office of the Chief Clerk; video archives available at http://www.azleg.gov/)
---------- DOCUMENT FOOTER ---------
IN-HOME CARE PROVIDERS STUDY COMMITTEE
December 5, 2007 December 4, 2007
2
---------- DOCUMENT FOOTER ---------