Legislature(2017 - 2018)ADAMS ROOM 519

04/19/2018 01:30 PM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Recessed to a Call of the Chair --
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved HCS CSSB 105(FIN) Out of Committee
Heard & Held
CS FOR SENATE BILL NO. 105(FIN)                                                                                               
     "An  Act  relating  to the  licensure  of  marital  and                                                                    
     family therapists;  relating to medical  assistance for                                                                    
     marital and family therapy  services; and providing for                                                                    
     an effective date."                                                                                                        
1:35:47 PM                                                                                                                    
Co-Chair  Foster  indicated that  bill  had  been heard  the                                                                    
prior day, April 18, 2018.                                                                                                      
1:36:20 PM                                                                                                                    
SENATOR DAVID WILSON, SPONSOR, he  did not have any comments                                                                    
but was available for questions.                                                                                                
1:37:04 PM                                                                                                                    
Vice-Chair Gara referenced Page  3 of the legislation, which                                                                    
said  that  Marital and  Family  Therapy  Services would  be                                                                    
covered.   He   asked   whether   that   included   marriage                                                                    
counseling. He  stated that  the covered  items in  the bill                                                                    
were  limited to  what was  covered under  Medicaid and  the                                                                    
things covered  by Medicaid were  mental health  related. He                                                                    
contended  that  the  bill  would  not  expand  services  to                                                                    
include  traditional,  non-mental   health  related  marital                                                                    
Co-Chair  Foster  recognized  Representative Pruitt  at  the                                                                    
1:38:14 PM                                                                                                                    
Co-Chair Seaton MOVED to ADOPT Amendment 1 (copy on file):                                                                      
     Page 4, following line 8:                                                                                                  
             Insert a new bill section to read:                                                                                 
     "* Sec.  5. The uncodified  law of the State  of Alaska                                                                  
     is amended by adding a new section to read:                                                                                
               REPORT TO LEGISLATURE.  (a) The Department of                                                                    
     Health and Social Services shall  prepare a report that                                                                    
     describes the  effectiveness and  cost-effectiveness of                                                                    
     the coverage of marital  and family therapy services as                                                                    
     provided in  AS 47.07.030(b). as  amended by sec.  3 of                                                                    
     this Act.  The report must include  the distribution of                                                                    
     services  provided by  billing code  and the  diversion                                                                    
     from more expensive alternatives.                                                                                          
               (b)  On  or  before November  30,  2020,  the                                                                    
     Department of Health and  Social Services shall deliver                                                                    
     the  report under  (a) of  this section  to the  senate                                                                    
     secretary  and   the  chief  clerk  of   the  house  of                                                                    
     representatives  and notify  the  legislature that  the                                                                    
     report is available."                                                                                                      
     Renumber the following bill sections accordingly.                                                                          
     Page 4, line I 0:                                                                                                          
             Delete "sec. 511                                                                                                   
             Insert "sec. 6"                                                                                                    
Representative Wilson OBJECTED.                                                                                                 
Co-Chair Seaton  asked whether the department  could comment                                                                    
on the date of November 30, 2020.                                                                                               
1:38:44 PM                                                                                                                    
MARGARET   BRODIE,  DIRECTOR,   DIVISION   OF  HEALTH   CARE                                                                    
SERVICES,  DEPARTMENT OF  HEALTH  AND  SOCIAL SERVICES  (via                                                                    
teleconference), indicated that  November 30th an acceptable                                                                    
1:39:29 PM                                                                                                                    
Co-Chair  Seaton  asked whether  the  year  should be  2021,                                                                    
rather than 2020.                                                                                                               
Ms. Brodie  indicated the 2020  report would  be preliminary                                                                    
data but  would not be  a good  foundation on which  to base                                                                    
any decisions. A comprehensive report  could be completed by                                                                    
2021  and would  include all  the information  necessary for                                                                    
sound decision making.                                                                                                          
1:40:25 PM                                                                                                                    
Co-Chair Seaton MOVED to ADOPT Conceptual Amendment 1:                                                                          
     Line 10:                                                                                                                   
     Change the date to 2021 rather than 2020.                                                                                  
There being NO OBJECTION, it was so ordered.                                                                                    
Co-Chair  Foster  asked whether  the  sponsor  of the  House                                                                    
companion bill wished to comment.                                                                                               
1:41:09 PM                                                                                                                    
REPRESENTATIVE  IVY  SPOHNHOLZ,   supported  the  conceptual                                                                    
Representative Wilson WITHDREW her OBJECTION.                                                                                   
There being NO OBJECTION, it was so ordered.                                                                                    
1:42:02 PM                                                                                                                    
Representative Wilson  MOVED to  ADOPT Amendment 2  (copy on                                                                    
Representative Gara OBJECTED.                                                                                                   
Representative   Wilson   explained   that   the   amendment                                                                    
addressed the concern that once  something had been added to                                                                    
Medicaid it could  not be removed. She said  that she wanted                                                                    
the  report to  have  meaningful impact  and  a sunset  date                                                                    
would force the legislature to regularly audit programs.                                                                        
Co-Chair Foster invited  the bill sponsor to  comment on the                                                                    
Senator Wilson  respectfully opposed the amendment.  He felt                                                                    
that if the amendment were to  pass, he would want to see an                                                                    
effective  date   change  so   that  providers   could  meet                                                                    
requirements.   He   worried   that  the   amendment   would                                                                    
negatively affect family therapists.                                                                                            
1:45:14 PM                                                                                                                    
Vice-Chair  Gara asked  how  difficult it  was  to become  a                                                                    
certified Medicaid biller.                                                                                                      
Ms.  Brodie  explained  that  the   first  thing  a  medical                                                                    
provider  had to  do was  to  enroll in  the program,  which                                                                    
included at  $500, out  of pocket,  fee. She  furthered that                                                                    
providers then  had to provide  proof of their  business and                                                                    
occupational  licenses.   A  recent   issue  was   that  the                                                                    
providers  had  to  provide full  ownership  and  disclosure                                                                    
information; including  all the  social security  numbers of                                                                    
their owners and board members.  Individuals that worked for                                                                    
Medicaid  had  to   have  background  checks.  Additionally,                                                                    
individuals would  need to be  certified by the  Division of                                                                    
Behavioral Health and would have  to have proof of insurance                                                                    
and an MPI number. Some providers  had to have first aid and                                                                    
CPR certification.  Providers also  had to provide  proof of                                                                    
liability   insurance   and   sign  a   Medicaid   providers                                                                    
agreement.  Some providers  could be  required to  perform a                                                                    
pre-enrollment  site visit.  She said  that the  state would                                                                    
put the  provider into  one of  three categories:  low risk,                                                                    
medium  risk,   or  high  risk;  she   believed  that  these                                                                    
providers  would  fall into  the  medium  risk category  and                                                                    
would be  on a 5-year  revalidation schedule.  She clarified                                                                    
that all  those requirements were  just to sign  up. Billing                                                                    
was  another story;  electronic  billing  would require  new                                                                    
software and  the building of interfaces  for the Enterprise                                                                    
system. She  stressed that electronic  billing significantly                                                                    
ramped up  the security  and auditing  requirements required                                                                    
for  computer  systems. Annual  billing  by  paper would  be                                                                    
available but would add to payment delays.                                                                                      
1:48:39 PM                                                                                                                    
Vice-Chair Gara  asked whether training  was required  to be                                                                    
able to do Medicaid billing.                                                                                                    
Ms.  Brodie  responded  that   there  was  ongoing  training                                                                    
required;  regularly   changing  codes   required  continual                                                                    
training.  She  said  that additional  administrative  staff                                                                    
could  be needed.  She shared  that there  were over  10,000                                                                    
denial  messages   that  a  provider  could   get  and  that                                                                    
providers would need  to review the list each  time in order                                                                    
to understand the nature of a denial.                                                                                           
1:49:59 PM                                                                                                                    
Vice-Chair  Gara  thought  the  legislature had  to  make  a                                                                    
choice of  whether to  include the  listed programs.  He was                                                                    
also uncertain  whether therapists would want  to go through                                                                    
all the hoops  again with a sunset date in  place. He warned                                                                    
that  a sunsetted  bill was  not easy  to reenact;  the bill                                                                    
would  disappear,  and  the legislature  would  have  to  go                                                                    
through the entire process again.                                                                                               
Representative Wilson  clarified that  the sunset  date only                                                                    
applied to the Medicaid a portion of the bill.                                                                                  
1:51:31 PM                                                                                                                    
Representative  Ortiz   asked  about  the  upfront   fee  to                                                                    
providers  for  enrollment. He  asked  whether  the fee  was                                                                    
annual and who received the fee.                                                                                                
Ms. Brodie indicated  that the fee was not  an annual charge                                                                    
but  did  have to  be  paid  again during  the  revalidation                                                                    
process.  She  said   that  the  fee  offset   the  cost  of                                                                    
enrollment  with  the  state   and  the  federal  government                                                                    
because it had become onerous for all entities involved.                                                                        
Representative Ortiz asked who received the fees.                                                                               
Ms. Brodie  responded that the  money was paid to  the state                                                                    
then  the  state  paid  50   percent  back  to  the  federal                                                                    
Representative Wilson asked how many  years it would take to                                                                    
find out whether  the additional services had  none what was                                                                    
Ms. Brodie thought that it would  take a minimum of 3 years.                                                                    
She believed more enrollment would be seen after 24 months.                                                                     
Representative Wilson  asked whether 2024 would  be a better                                                                    
sunset date.                                                                                                                    
Ms.  Brodie responded  that the  department  would have  the                                                                    
full documentation and data analytics by 2024.                                                                                  
1:54:21 PM                                                                                                                    
Representative Wilson MOVED to  ADOPT Conceptual Amendment 1                                                                    
to Amendment 2. The amendment  would change the date on Line                                                                    
9, from 2021 to 2024.                                                                                                           
There  being   NO  OBJECTION,  Conceptual  Amendment   1  to                                                                    
Amendment 2 was ADOPTED.                                                                                                        
1:55:20 PM                                                                                                                    
Representative Tilton  asked about Medicaid  billing courses                                                                    
that were already available.                                                                                                    
Ms.  Brodie  responded  that   there  were  individuals  who                                                                    
trained  in  medical  coding,   the  only  individuals  that                                                                    
trained in Medicaid coding were the division and Conduent.                                                                      
1:56:08 PM                                                                                                                    
Co-Chair  Seaton  referred  to   Amendment  1.  He  wondered                                                                    
whether  the date  should  be changed  to  November 30th  in                                                                    
Amendment 2.                                                                                                                    
Ms.  Brodie responded  that  notice to  stop  a benefit  was                                                                    
usually  given  to all  providers  and  recipients ahead  of                                                                    
time,  typically July  1st  or January  1st.  She said  that                                                                    
other dates could be considered  but were not typical of the                                                                    
Medicaid program.                                                                                                               
1:57:08 PM                                                                                                                    
Representative Wilson  did not want  to kill a  program, but                                                                    
rather to force the legislature to look at it periodically.                                                                     
She worried  that unsuccessful programs would  be added that                                                                    
did not  produce the  intended results.  She noted  that the                                                                    
program was  costly and believed  that it should  be audited                                                                    
at least once before renewal.                                                                                                   
Vice-Chair Gara MAINTAINED his OBJECTION.                                                                                       
A roll call vote was taken on the motion.                                                                                       
IN FAVOR:   Tilton, Wilson, Ortiz, Pruitt, Thompson,                                                                            
OPPOSED:    Gara,   Grenn,  Guttenberg,   Kawasaki,  Seaton,                                                                    
The MOTION FAILED (5/6).                                                                                                        
2:00:06 PM                                                                                                                    
AT EASE                                                                                                                         
2:00:39 PM                                                                                                                    
Vice-Chair  Gara  reviewed  the  previously  publish  fiscal                                                                    
     FN3 - Fiscal Impact Note                                                                                                   
     Department: Department of Commerce, Community and                                                                          
     Economic Development                                                                                                       
     Appropriation: Corporations, Business and Professional                                                                     
     Allocation: Corporations, Business and Professional                                                                        
     OMB Component Number: 2360                                                                                                 
     FN4 - Fiscal Impact Note                                                                                                   
     Department: Department of Health and Social Services                                                                       
     Appropriation: Medicaid Services                                                                                           
     Allocation: Behavioral Health Medicaid Services                                                                            
     OMB Component Number: 2660                                                                                                 
2:02:19 PM                                                                                                                    
Co-Chair Seaton  MOVED to  report HCSCSSB  105 (FIN)  out of                                                                    
Committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal notes.                                                                                                      
Representative Wilson OBJECTED.                                                                                                 
Representative  Wilson  reiterated  her  concern  about  the                                                                    
addition of a possibly  unsuccessful program to the Medicaid                                                                    
Co-Chair Seaton shared  that he supported a  sunset date for                                                                    
the program.                                                                                                                    
2:05:40 PM                                                                                                                    
Representative Pruitt  lamented that the state  did not have                                                                    
a fiscal  plan, but it  was adding services to  Medicaid. He                                                                    
expressed concern for adding to long-term costs.                                                                                
2:07:15 PM                                                                                                                    
Representative   Guttenberg   commented    that   the   bill                                                                    
represented the  ability to deliver services  to keep people                                                                    
out  of  higher cost  situations.  He  thought it  was  cost                                                                    
avoidance and was part of a  plan to deal with healthcare in                                                                    
the state.                                                                                                                      
A roll call vote was taken on the motion.                                                                                       
IN FAVOR: Gara, Grenn,  Guttenberg, Kawasaki, Ortiz, Foster,                                                                    
OPPOSED: Wilson, Pruitt, Thompson, Tilton                                                                                       
The MOTION PASSED (7/4).                                                                                                        
HCS CSSB 105 (FIN) was REPORTED  out of committee with a "do                                                                    
pass"  recommendation  and  with  two  previously  published                                                                    
fiscal impact notes: FN3 (CED) and FN4 (DHS).                                                                                   
2:09:29 PM                                                                                                                    
AT EASE                                                                                                                         
2:10:50 PM                                                                                                                    

Document Name Date/Time Subjects
SB 105 - Marital & Family Therapy Q & A Summary.pdf HFIN 4/19/2018 1:30:00 PM
SB 105
CSSB 105(FIN) - Mat Su Health Foundation testimony.pdf HFIN 4/19/2018 1:30:00 PM
SB 105
CSSB 105(FIN) AK Behavioral Health System Assessment 2016.pdf HFIN 4/19/2018 1:30:00 PM
SB 105
SB 105 Amendments.pdf HFIN 4/19/2018 1:30:00 PM
SB 105
SB 105 - New amendment #1 N.4.pdf HFIN 4/19/2018 1:30:00 PM
SB 105
SB 102 FY16 Broadband Totals and District Subsidies 4.18.18.pdf HFIN 4/19/2018 1:30:00 PM
SB 102
SB 105 Response to HFIN Questions DHSS Brodie 041918.pdf HFIN 4/19/2018 1:30:00 PM
SB 105