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SENATE BILL NO. 154
IN THE LEGISLATURE OF THE STATE OF ALASKA
THIRTY-FOURTH LEGISLATURE - FIRST SESSION
BY SENATOR YUNDT
Introduced: 4/2/25
Referred: Labor and Commerce, Finance
A BILL
FOR AN ACT ENTITLED
"An Act establishing the Home Care Employment Standards Advisory Board; relating 1
to payment for personal care services; and providing for an effective date." 2
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 3
* Section 1. AS 44.29 is amended by adding new sections to read: 4
Article 10. Home Care Employment Standards Advisory Board. 5
Sec. 44.29.900. Home Care Employment Standards Advisory Board. The 6
Home Care Employment Standards Advisory Board is established in the department. 7
Sec. 44.29.905. Composition of the board. The board consists of 8
(1) the commissioner of health or the commissioner's designee, who 9
shall serve as the chair and is a nonvoting member, except in the case of a tie; 10
(2) the commissioner of labor and workforce development or the 11
commissioner's designee, who is a nonvoting member; and 12
(3) eight members appointed by the commissioner of health, as 13
follows: 14 34-LS0836\A
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(A) two voting members who represent covered providers, 1
including at least one agency that provided at least 700,000 units of personal 2
care services during the previous calendar year and one agency that provides 3
habilitation services; 4
(B) two voting members who represent direct care workers, at 5
least one of whom is a labor representative of at least 300 direct care workers; 6
a member appointed under this subparagraph may not be a representative of an 7
organization or association that advocates for the interests of covered providers 8
or agencies that provide covered services; 9
(C) one voting member who is an enrollee or a representative 10
of enrollees receiving covered services; 11
(D) one voting member who represents the office within the 12
department with responsibility for rate review; 13
(E) one nonvoting member who represents the Alaska 14
Commission on Aging or another organization that represents seniors in the 15
state; and 16
(F) one nonvoting member who represents the Governor's 17
Council on Disabilities and Special Education established under AS 44.29.600 18
or another organization that represents people with disabilities in the state. 19
Sec. 44.29.910. Term of office, vacancies, and removal of appointed 20
members. (a) The members of the board appointed under AS 44.29.905(3) serve two-21
year terms and may be reappointed. 22
(b) A member of the board appointed under AS 44.29.905(3) serves at the 23
pleasure of the commissioner, except that the commissioner shall remove a member 24
who no longer meets the qualifications of the seat for which the member was 25
appointed. 26
(c) The commissioner may appoint an individual to fill a vacancy under 27
AS 44.29.905(3) only after providing public notice of the vacancy and soliciting 28
applications for the appointment. The commissioner shall fill the vacancy within six 29
months after the date the vacancy occurs. An appointment to fill the vacancy is for the 30
remainder of the unexpired term. 31 34-LS0836\A
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Sec. 44.29.915. Meetings. The board shall meet at the call of the chair. The 1
board shall meet at least three times each year and shall hold additional meetings as 2
often as necessary to accomplish the duties of the board. A meeting may be held in 3
person or by teleconference or other electronic means. At each meeting, the board 4
shall provide time for public testimony. 5
Sec. 44.29.920. Quorum. A majority of the voting members of the board 6
constitute a quorum for the transaction of business, and a majority of a quorum present 7
at a meeting is sufficient to approve a recommendation of the board. 8
Sec. 44.29.925. Compensation. Members of the board receive no 9
compensation for service on the board but are entitled to per diem and travel expenses 10
authorized for boards and commissions under AS 39.20.180. 11
Sec. 44.29.930. Powers and duties of the board. (a) The board shall 12
(1) advise and consult with the department on the medical assistance 13
program payment rates for covered services and payment rate adequacy and 14
compliance with federal requirements regarding reporting of payment adequacy data; 15
(2) investigate matters related to the wages, working conditions, and 16
workforce adequacy of workers providing covered services in the state, including 17
(A) the adequacy of wages, benefits, and other compensation to 18
ensure the provision of quality services and sufficient levels of recruitment and 19
retention; 20
(B) the sufficiency of levels of recruitment for and retention of 21
workers, particularly in an area that is not on a road system; 22
(C) the sufficiency of service levels of and the effect of service 23
level reductions on covered services, as the services pertain to wages and 24
working conditions; 25
(D) the adequacy and enforcement of training requirements; 26
(E) the effect of workforce shortages on service recipients and 27
on family members and friends of service recipients providing unpaid care, 28
including compliance with federal requirements to report information to the 29
United States Department of Health and Human Services, Centers for
30
Medicare and Medicaid Services, regarding wait times for covered services 31 34-LS0836\A
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and the percentage of authorized hours for covered services; 1
(F) the economic impact of achieving a living wage for direct 2
care workers and reducing levels of unpaid care; 3
(G) the adequacy of payment practices and policies related to 4
the payment rates of certified providers of covered services; and 5
(H) the effect of the state's long-term care system on wages and 6
working conditions. 7
(b) A state agency that receives a reasonable request for information or 8
testimony from the board shall comply with the request as soon as is reasonably 9
practicable, and, when the board requests direct testimony for a board meeting, the 10
head of the agency or the designee of the head of the agency shall appear at the 11
meeting and provide testimony. 12
(c) The department shall ensure the board has access to current and proposed 13
payment rates, payment adequacy reporting information for covered services that is 14
provided by the state to the United States Department of Health and Human Services, 15
Centers for Medicare and Medicaid Services, as required by federal law, and access to 16
metrics created by the state that contain information regarding wait times for covered 17
services and the percentage of authorized hours for covered services. 18
Sec. 44.29.935. Biennial report. (a) The board shall biennially prepare a 19
written report, submit the report to the commissioner, the legislative committees 20
having jurisdiction over health and social services, and the chief clerk of the house of 21
representatives and the senate secretary, and notify the legislature that the report is 22
available. The commissioner shall make the report and all materials presented before 23
the board available to the public on the department's Internet website. 24
(b) The biennial report must be based on the results of the board's 25
investigation under AS 44.29.930(a)(2) and must include key findings and 26
recommendations regarding 27
(1) rates and service levels of covered services; 28
(2) adequacy of rates and service levels of covered services to ensure 29
the provision of quality services, improved recruitment and retention, and compliance 30
with federal standards; 31 34-LS0836\A
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(3) safe and healthy working conditions for workers providing covered 1
services; 2
(4) reducing any barrier to recruiting for and retaining workers 3
providing covered services throughout the state, particularly in an area that is not on a 4
road system; 5
(5) reducing the level of unpaid care in the state and systemic 6
overreliance on family members and friends of service recipients who provide unpaid 7
care; and 8
(6) sufficiency of covered services payment adequacy data and access 9
to care metrics. 10
(c) Upon receiving the biennial report, the commissioner shall review the 11
board's findings and recommendations. The commissioner may 12
(1) accept or reject a recommendation; and 13
(2) require the board to conduct new or further investigations and 14
develop new recommendations. 15
(d) If the commissioner accepts a recommendation in the biennial report, the 16
department shall adopt regulations necessary to implement the recommendation. If the 17
commissioner rejects a recommendation in the biennial report, the commissioner shall 18
provide a written explanation of the commissioner's decision to all board members and 19
the legislative committees having jurisdiction over health and social services. If the 20
reason for rejection includes budgetary constraints, the commissioner shall work with 21
the Office of the Governor and the legislature to develop a budget proposal that would 22
allow the commissioner to accept the recommendation. 23
Sec. 44.29.940. Publication of reports. On July 1 of each year, or within 30 24
days after receiving the biennial report from the board, the department shall publish on 25
the department's publicly available Internet website an annual report containing the 26
weighted average of and median hourly wages, by agency, for workers providing 27
covered services. 28
Sec. 44.29.945. Definitions. In AS 44.29.900 - 44.29.945, 29
(1) "board" means the Home Care Employment Standards Advisory 30
Board; 31 34-LS0836\A
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(2) "commissioner" means the commissioner of health; 1
(3) "covered provider" means an eligible Medicaid provider enrolled 2
with the department to provide one or more covered services; 3
(4) "covered services" means 4
(A) chore services provided under a section 1915(k) option 5
under 42 U.S.C. 1396n; 6
(B) hourly respite services provided under a waiver in 7
accordance with 42 U.S.C. 1396 - 1396p; 8
(C) personal care services; 9
(D) habilitation services; 10
(5) "department" means the Department of Health; 11
(6) "direct care worker" means an individual who is employed by a 12
covered provider to provide one or more covered services; 13
(7) "habilitation services" means services designed to assist individuals 14
in acquiring, retaining, and improving the self-help, socialization, and adaptive skills 15
necessary to reside successfully in home and community-based settings, provided 16
under a waiver in accordance with 42 U.S.C. 1396 - 1396p; 17
(8) "personal care services" means services provided under a section 18
1915(k) option under 42 U.S.C. 1396n, under AS 47.07.030, or under a waiver in 19
accordance with 42 U.S.C. 1396 - 1396p. 20
* Sec. 2. AS 47.07.045 is amended by adding new subsections to read: 21
(f) Except as provided in (g) of this section, an agency providing home and 22
community-based services shall pay as compensation and benefits to its employees 23
performing personal care services, 24
(1) beginning July 1, 2026, at least 70 percent of the total annual 25
amount of funding the agency receives for personal care services from the department; 26
and 27
(2) beginning July 1, 2030, at least 80 percent of the total annual 28
amount of funding the agency receives for personal care services from the department. 29
(g) The department may grant to an agency providing home and community-30
based services a hardship exemption from the requirements of (f) of this section if the 31 34-LS0836\A
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agency is facing extraordinary circumstances or is a small provider, as defined by the 1
department. The department shall adopt regulations establishing procedures and 2
objective criteria for granting a hardship exemption under this subsection. An agency 3
that is granted a hardship exemption shall pay as compensation and benefits to its 4
employees performing personal care services, 5
(1) beginning July 1, 2026, at least 60 percent of the total annual 6
amount of funding the agency receives for personal care services from the department; 7
and 8
(2) beginning July 1, 2036, at least 80 percent of the total annual 9
amount of funding the agency receives for personal care services from the department. 10
(h) The amount calculated under (f) and (g) of this section for compensation 11
and benefits paid to employees may not include costs expended on employees by an 12
agency for personal protective equipment, required training, and travel costs such as 13
mileage reimbursement or public transportation. 14
(i) In this section, "personal care services" has the meaning given in 15
AS 44.29.945. 16
* Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to 17
read: 18
APPOINTMENTS, FIRST MEETING, AND PRELIMINARY REPORT. (a) The fi rst 19
meeting of the Home Care Employment Standards Advisory Board established under 20
AS 44.29.900, added by sec. 1 of this Act, must take place on or before October 1, 2025. 21
(b) The commissioner of health shall appoint all board members under 22
AS 44.29.905(3), added by sec. 1 of this Act, before the board's first meeting. 23
(c) The commissioner of health or the commissioner's designee and the commissioner 24
of labor and workforce development or the commissioner's designee shall conduct a 25
preliminary investigation into the wages, working conditions, and adequacy of the Medicaid 26
workforce providing covered services in the state and present the results of the preliminary 27
investigation to the board at the board's first meeting. 28
* Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to 29
read: 30
PRELIMINARY INTERNET WEBSITE PUBLICATION. Notwithstanding 31 34-LS0836\A
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AS 44.29.940, added by sec. 1 of this Act, the Department of Health shall make the first 1
publication of the reports required by AS 44.29.940, added by sec. 1 of this Act, on the 2
department's Internet website not later than July 1, 2026. 3
* Sec. 5. The uncodified law of the State of Alaska is amended by adding a new section to 4
read: 5
MEDICAID STATE PLAN. To the extent necessary to implement this Act, the 6
Department of Health shall amend and submit for approval by the United States Department 7
of Health and Human Services the state plan under AS 47.07.045, as amended by sec. 2 of 8
this Act. 9
* Sec. 6. The uncodified law of the State of Alaska is amended by adding a new section to 10
read: 11
CONDITIONAL EFFECT; NOTIFICATION. (a) Section 2 of this Act takes effect 12
only if, and to the extent that, on or before January 1, 2026, the United States Department of 13
Health and Human Services 14
(1) approves amendments submitted in accordance with sec. 5 of this Act; or 15
(2) determines that approval of the amendments to the state plan under 16
AS 47.07.045 is not necessary. 17
(b) The commissioner of health shall notify the revisor of statutes in writing within 30 18
days after the United States Department of Health and Human Services approves amendments 19
to the state plan or determines that approval is not necessary under this section. 20
* Sec. 7. If sec. 2 of this Act takes effect, it takes effect on the day after the date on which 21
the United States Department of Health and Human Services approves the amendments to the 22
state plan submitted under sec. 5 of this Act or determines that approval is not necessary 23
under sec. 6 of this Act. 24
* Sec. 8. Except as provided in sec. 7 of this Act, this Act takes effect July 1, 2025. 25