Legislature(2009 - 2010)HOUSE FINANCE 519

04/11/2010 12:30 PM FINANCE


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Recessed to 6:30 pm Today --
+ HB 296 ENERGY EFFICIENCY BONDS; LOANS; FUND TELECONFERENCED
Moved CSHB 296(ENE) Out of Committee
+ HB 416 PRUDENT MANAGEMENT OF INSTITUTIONAL FUNDS TELECONFERENCED
Moved Out of Committee
*+ HB 421 PUBLIC EMPLOYEE SALARIES TELECONFERENCED
Heard & Held
+= HB 424 G.O. BONDS FOR EDUCATION PROJECTS TELECONFERENCED
Moved CSHB 424(FIN) Out of Committee
+ SB 199 MEDICAID COVERAGE FOR DENTURES TELECONFERENCED
Moved Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
SENATE BILL NO. 199                                                                                                           
                                                                                                                                
     "An Act providing for a two-year funding cycle for                                                                         
     medical assistance coverage for dentures."                                                                                 
                                                                                                                                
2:24:31 PM                                                                                                                    
                                                                                                                                
                                                                                                                                
2:24:55 PM          AT EASE                                                                                                   
2:29:50 PM          RECONVENED                                                                                                
                                                                                                                                
SENATOR   JOHNNIE  ELLIS,   SPONSOR,   explained  that   the                                                                    
legislation would  allow clients covered under  the Medicaid                                                                    
Adult Preventative  Dental program  (APD) to get  a complete                                                                    
set  of upper  and lower  dentures in  same fiscal  year. He                                                                    
remarked that  this would  allow the  client to  "chew their                                                                    
food."  The plan  to  divide the  denture  benefit into  two                                                                    
fiscal  years was  adopted  as a  cost  savings measure.  He                                                                    
shared  a  personal  story  of  a  constituent's  experience                                                                    
needing dentures  under adult  dental Medicaid  that spurred                                                                    
his involvement  with the legislation.  He relayed  that the                                                                    
constituent   was  distraught   and  contemplating   suicide                                                                    
because he  could not  eat or  speak clearly  without teeth.                                                                    
Acquiring half a  set of dentures was  useless and prolonged                                                                    
his misery for  an entire year. He believed  that there will                                                                    
be a cost savings to the program with the legislation.                                                                          
                                                                                                                                
2:33:17 PM                                                                                                                    
                                                                                                                                
Representative  Foster  wondered  what  the  intent  of  the                                                                    
original  legislation was;  to  divide  the denture  benefit                                                                    
into two fiscal years. Senator  Ellis restated that it was a                                                                    
cost  containment measure  intended  to  divide the  benefit                                                                    
over  fiscal years.  He felt  that overall  the program  was                                                                    
"great" and well  intended but this aspect  was not properly                                                                    
considered. He believed that this  type of situation created                                                                    
public  skepticism toward  government  and  could be  easily                                                                    
remedied to restore credibility.                                                                                                
                                                                                                                                
DR. DAVID  LOGAN, DDS, DENTIST,  ALASKA DENTAL  SOCIETY (via                                                                    
teleconference), testified  in favor of the  legislation. He                                                                    
indicated that  the program  benefits all  parties involved.                                                                    
The  patient's  dignity  and  quality  of  health  would  be                                                                    
restored.  The dentist  would  deliver  the denture  service                                                                    
more  effectively by  performing the  same procedures  for a                                                                    
set of  dentures once, rather  than individually;  that also                                                                    
reduces  patient travel  expenses for  multiple visits  from                                                                    
rural  areas. The  efficiency would  create cost  savings to                                                                    
the state.  There would  also be  a preventative  benefit by                                                                    
the  removal   of  diseased   and  abscessed   teeth  before                                                                    
infection  sets  in  and   requires  additional  dental  and                                                                    
expensive(i.e.  emergency  room  visits)  medical  services;                                                                    
creating additional cost savings.                                                                                               
                                                                                                                                
Co-Chair Hawker cited the fiscal  note for the Department of                                                                    
Health and  Social Services,  FN2 (DHSS),  in the  amount of                                                                    
$935 thousand  for FY  2011. He  noted that  the expenditure                                                                    
decreases to $467.5 thousand in FY  2012 and is zero for the                                                                    
subsequent years.  He wondered if  the program has  a sunset                                                                    
provision and asked for an explanation of the fiscal note.                                                                      
                                                                                                                                
JON SHERWOOD, MEDICAID SPECIAL  PROJECTS, DIVISION OF HEALTH                                                                    
CARE  SERVICES, DEPARTMENT  OF HEALTH  AND SOCIAL  SERVICES,                                                                    
answered  that the  sunset on  the  Adult Preventive  Dental                                                                    
program had  been eliminated. He  furthered that  the fiscal                                                                    
note   reflects   an   initial   anticipated   increase   in                                                                    
expenditures as  APD provides both upper  and lower dentures                                                                    
in the same fiscal year for  the first two years. There will                                                                    
be patients  receiving their second year  denture along with                                                                    
new patients  entitled to both  dentures in the  same fiscal                                                                    
year.  The  department feels  that  by  the third  year  the                                                                    
program will have caught up  with the initial impacts of the                                                                    
expanded benefit.                                                                                                               
                                                                                                                                
2:43:11 PM                                                                                                                    
                                                                                                                                
Co-Chair Hawker asked if the  demand for the APD program was                                                                    
expected to  decline. Mr. Sherwood  replied that  the fiscal                                                                    
note does not  assume a decrease in the  out years. Co-Chair                                                                    
Hawker recalled that  in the early years of  the APD program                                                                    
costs were  overestimated. Co-Chair  Hawker wondered  if the                                                                    
same  situation applied  to the  fiscal  note. Mr.  Sherwood                                                                    
explained that  fiscal notes  reflect the  department's best                                                                    
reasonable estimate of costs.                                                                                                   
                                                                                                                                
Representative  Austerman asked  what the  original estimate                                                                    
of the program's cost was.  Mr. Sherwood guessed that it was                                                                    
approximately $10 million.                                                                                                      
                                                                                                                                
                                                                                                                                
Co-Chair  Hawker  remembered  that  the  original  APD  bill                                                                    
placed a  limit on the  aggregate amount of  funds available                                                                    
for the  program in  a year. The  aggregate cap  was removed                                                                    
from  the  program  when  the  sunset  was  eliminated.  The                                                                    
utilization of  the program was  under anticipated  costs at                                                                    
approximately $7.5  million, half of the  amount was federal                                                                    
funds and half was general funds.                                                                                               
                                                                                                                                
Representative Austerman  asked how much money  is currently                                                                    
appropriated for the APD program  excluding the fiscal note.                                                                    
Mr. Sherwood  did not  know. He wanted  to clarify  that the                                                                    
APD program included many other services besides dentures.                                                                      
                                                                                                                                
2:48:54 PM                                                                                                                    
                                                                                                                                
Co-Chair  Hawker reported  that the  FY 2009  actual expense                                                                    
level was $5.9 million, and  the FY 2010 total appropriation                                                                    
was $7.3  million. The  FY 2008  governors request  was $8.1                                                                    
million.                                                                                                                        
                                                                                                                                
Representative  Austerman felt  that  the department  should                                                                    
know  the amount  currently appropriated  in the  budget for                                                                    
the  program. Co-Chair  Hawker agreed  that the  fiscal note                                                                    
request appeared speculative.                                                                                                   
                                                                                                                                
Mr. Sherwood  explained that the  benefit is  relatively new                                                                    
and the fiscal  note amount was based on a  best estimate of                                                                    
the  legislations  impact  regardless  of  the  base  amount                                                                    
appropriated.                                                                                                                   
                                                                                                                                
Representative Gara  observed that out of  the $935 thousand                                                                    
fiscal note  (FN 2 (DHS))  expenditure, $626.5  thousand are                                                                    
federal  funds and  $308.6 thousand  are  general funds.  He                                                                    
discerned  that  the  "upfront"  additional  cost  for  both                                                                    
dentures this year means the  expenditures will be that much                                                                    
less next  year. He felt  that over  the long term  the same                                                                    
amount  of money  will  be  spent and  the  fiscal note  was                                                                    
misleading; it  only appears there  will be extra  costs. He                                                                    
deduced  that the  initial costs  will be  leveled out  to a                                                                    
zero dollar increment  over the long term.  He surmised that                                                                    
the department should request  additional funds for services                                                                    
provided this year but request less for next year.                                                                              
                                                                                                                                
2:53:46 PM                                                                                                                    
                                                                                                                                
Representative  Kelly commented  that  he  agreed with  Rep.                                                                    
Gara that the increment "washes  out" over time and supports                                                                    
the legislation.                                                                                                                
                                                                                                                                
Co-Chair  Hawker shared  that  he authored  the initial  APD                                                                    
bill  because the  only dental  Medicaid services  available                                                                    
for adults was for a  crisis situation which the patient had                                                                    
to experience  infection or acute  pain. He felt that  was a                                                                    
"barbaric" system.                                                                                                              
                                                                                                                                
Representative Fairclough  asked about differences  of sixty                                                                    
percent and  fifty seven percent  in the federal  match rate                                                                    
between FY  2011 and  FY 2012 depicted  on the  fiscal note.                                                                    
Mr.  Sherwood  explained that  the  decline  in the  federal                                                                    
match  rate in  FY 2012  is due  to the  phasing out  of the                                                                    
stimulus funds.                                                                                                                 
                                                                                                                                
Vice-Chair  Thomas asked  about the  annual denture  benefit                                                                    
limit in terms of lost dentures.                                                                                                
                                                                                                                                
2:58:33 PM                                                                                                                    
                                                                                                                                
Mr. Sherwood  answered that there  is a dollar limit  on the                                                                    
amount  of annual  dental benefit,  if replacement  dentures                                                                    
exceeds the  limit a  patient would have  to wait  until the                                                                    
second year.  The annual monetary  limit is only  enough for                                                                    
an upper or lower denture.                                                                                                      
                                                                                                                                
Co-Chair Hawker directed attention to  the fiscal note, FN 1                                                                    
(DHS) that was  zeroed out in Senate Finance.  He noted that                                                                    
the   fiscal  note   had  requested   a  personal   services                                                                    
expenditure of $183.3 thousand for  two full time employees.                                                                    
He  cited a  new fiscal  note,  from the  department in  the                                                                    
amount of $147.9  thousand dollars for one  employee for one                                                                    
year.  He  asked for  an  explanation  of the  request.  Mr.                                                                    
Sherwood  indicated that  originally the  department thought                                                                    
that the  claims processing  system could  not handle  a two                                                                    
year  spending  limit and  that  claims  would be  processed                                                                    
manually. Subsequently,  the department was able  to come up                                                                    
with a programming solution. The  new fiscal note reflects a                                                                    
request  for $50  thousand to  enhance  the existing  claims                                                                    
processing system or the new  system that is currently being                                                                    
developed. The remaining  amount is for one  person to track                                                                    
and  process   authorizations  until  the  new   system  can                                                                    
accommodate  automated processing.  The person  will not  be                                                                    
hired if the automated system is working.                                                                                       
                                                                                                                                
                                                                                                                                
Co-Chair Hawker  asked if the position  should be classified                                                                    
as temporary on the fiscal note. Mr. Sherwood affirmed.                                                                         
                                                                                                                                
Co-Chair Hawker noted  that the new fiscal  note will become                                                                    
number  four  when published  and  adjusted  to reflect  the                                                                    
position as temporary.                                                                                                          
                                                                                                                                
Representative  Fairclough   informed  the   committee  that                                                                    
dental issues  contribute to the  suicide rate in  the state                                                                    
and she will support the bill.                                                                                                  
                                                                                                                                
Co-Chair  Hawker MOVED  to report  SB 199  out of  Committee                                                                    
with individual recommendations  and the accompanying fiscal                                                                    
notes. There being NO OBJECTION, it was so ordered.                                                                             
                                                                                                                                
SB  199 was  REPORTED  out  of Committee  with  a "do  pass"                                                                    
recommendation  and with  attached  new fiscal  note by  the                                                                    
Department  of Health  and  Social  Services and  previously                                                                    
published fiscal note: FN2 (DHS).                                                                                               
                                                                                                                                
3:08:34 PM          AT EASE                                                                                                   
6:25:56 PM          RECONVENED                                                                                                
                                                                                                                                
                                                                                                                                

Document Name Date/Time Subjects
Energy Savings Performance Contracting Summary-DOT.pdf HFIN 4/11/2010 12:30:00 PM
HB 296
HB 296 AHFC SEP BondsL Sec Analysis.pdf HFIN 4/11/2010 12:30:00 PM
HB 296
HB 296 SEP bonds Sponsor Statement[1].pdf HFIN 4/11/2010 12:30:00 PM
HB 296
HB416 Sectional Analysis ver R.pdf HFIN 4/11/2010 12:30:00 PM
HB 416
HB416 Sponsor Statement ver R.pdf HFIN 4/11/2010 12:30:00 PM
HB 416
HB416 Supporting Documents History UMIFA and UPMIFA.pdf HFIN 4/11/2010 12:30:00 PM
HB 416
HB416 Supporting Documents UPMIFA_map.pdf HFIN 4/11/2010 12:30:00 PM
HB 416
HB416 Supporting Documents-Letter AG 3-18-10.pdf HFIN 4/11/2010 12:30:00 PM
HB 416
HB416 Supporting Documents-Letter AG 3-18-10.pdf HFIN 4/11/2010 12:30:00 PM
HB 416
HB416 Supporting Documents-Letter Foreaker Group.pdf HFIN 4/11/2010 12:30:00 PM
HB 416
HB416 Supporting Documents-Why Adopt UPMIFA.pdf HFIN 4/11/2010 12:30:00 PM
HB 416
10 HB 421 FN - pay raise 2010.pdf HFIN 4/11/2010 12:30:00 PM
HB 421
HB421-LEG-LEG-3-30-10NEW.pdf HFIN 4/11/2010 12:30:00 PM
HB 421
HB 421 Gov Transmittal Letter.pdf HFIN 4/11/2010 12:30:00 PM
HB 421
hearing_req_HB421_040710.pdf HFIN 4/11/2010 12:30:00 PM
HB 421
SUmmary by Dept hb 421 SB 310.pdf HFIN 4/11/2010 12:30:00 PM
HB 421
SB 310
H FIN letters of support.pdf HFIN 4/11/2010 12:30:00 PM
SB199-DHSS-MAA-2-9-10.pdf HFIN 4/11/2010 12:30:00 PM
SB 199
SFIN backup information.pdf HFIN 4/11/2010 12:30:00 PM
SB 199
sponsor statement.pdf HFIN 4/11/2010 12:30:00 PM
SB 199
HB421-Ex Branch-4-8-10.pdf HFIN 4/11/2010 12:30:00 PM
HB 421
CSHB424(FIN)-DOR-TRS-4-10-10 GO Bonds for Education.pdf HFIN 4/11/2010 12:30:00 PM
HB 424
HB 424 Sample Ballot.pdf HFIN 4/11/2010 12:30:00 PM
HB 424
CS WORKDRAFT HB424 (FIN) P VERSION and Sectional.pdf HFIN 4/11/2010 12:30:00 PM
HB 424