Legislature(2009 - 2010)CAPITOL 106

02/26/2009 03:00 PM HEALTH & SOCIAL SERVICES

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Heard & Held
Heard & Held
HB 26-MEDICAID FOR ADULT DENTAL SERVICES                                                                                      
3:11:37 PM                                                                                                                    
CO-CHAIR KELLER announced that the  first order of business would                                                               
be  HOUSE  BILL   NO.  26,  "An  Act  repealing   the  repeal  of                                                               
preventative and restorative  adult dental services reimbursement                                                               
under Medicaid; providing for an  effective date by repealing the                                                               
effective date of sec. 3, ch.  52, SLA 2006; and providing for an                                                               
effective date."                                                                                                                
3:12:04 PM                                                                                                                    
REPRESENTATIVE   MIKE  HAWKER,   Alaska  State   Legislature,  in                                                               
response to  Co-Chair Keller,  said that there  was a  reason for                                                               
not originally amending  the bill as the committee  had, but that                                                               
Version E was the will of the committee.                                                                                        
3:12:21 PM                                                                                                                    
CO-CHAIR HERRON moved to adopt  the proposed committee substitute                                                               
(CS) for  HB 26,  Version 26-LS0142\E,  Mischel, 2/20/09,  as the                                                               
working  document.   There  being  no  objection, Version  E  was                                                               
3:12:49 PM                                                                                                                    
REPRESENTATIVE HAWKER explained that,  until two years ago, adult                                                               
dental service  had only been  allowed through Medicaid  if there                                                               
were both acute pain and infection.   He noted that the 2007 bill                                                               
for preventive  care had  included a two  year sunset  clause, in                                                               
order to  monitor and review the  fiscal impact.  He  opined that                                                               
the program  had gone  quite well  and that  the growth  had been                                                               
reasonable.   He  reported that  the  health community  supported                                                               
making  HB 26  permanent.   He noted  that Version  E was  adding                                                               
another five year  limitation.  He explained that  this created a                                                               
challenge for  the development of  a provider base.   He reported                                                               
that  dentists made  more money  working  with regular  insurance                                                               
clients, rather  than Medicaid, and  that they were  reluctant to                                                               
work with a program of limited duration.                                                                                        
3:15:39 PM                                                                                                                    
REPRESENTATIVE  SEATON   asked  Representative  Hawker   for  his                                                               
preference to a limited or unlimited duration for HB 26.                                                                        
REPRESENTATIVE HAWKER offered his  belief that there was adequate                                                               
basis for it to become permanent.                                                                                               
3:16:44 PM                                                                                                                    
CO-CHAIR KELLER reported that he  had included a sunset clause in                                                               
HB 26 for the  purpose of discussion.  He added  that HB 26 would                                                               
next  be  referred to  the  House  Finance Committee,  which  was                                                               
chaired by Representative Hawker.                                                                                               
REPRESENTATIVE  HAWKER  said  that the  House  Finance  Committee                                                               
would take into consideration the  wishes of the House Health and                                                               
Social Services Standing Committee.                                                                                             
3:17:47 PM                                                                                                                    
REPRESENTATIVE  CISSNA  asked  Representative Hawker  to  clarify                                                               
that the reason for the  original sunset clause was economic, but                                                               
that the program had shown to  be a good preventive dental health                                                               
REPRESENTATIVE HAWKER agreed,  but said that there  had been many                                                               
unknowns,  including cost  and  utilization.   He  opined that  2                                                               
years had been adequate time for review.                                                                                        
REPRESENTATIVE  CISSNA  asked if  the  state  could monitor  this                                                               
program, and still review it without a sunset clause.                                                                           
3:19:58 PM                                                                                                                    
REPRESENTATIVE HAWKER  explained that  HB 26 merely  extended the                                                               
existing program, including the benefit parameters.                                                                             
3:20:43 PM                                                                                                                    
REPRESENTATIVE SEATON asked if there  was any significance to the                                                               
title change between HB 26 and Version E.                                                                                       
CO-CHAIR  KELLER said  that  the  intent was  only  to include  a                                                               
sunset clause.                                                                                                                  
3:22:15 PM                                                                                                                    
CO-CHAIR HERRON  questioned whether  the House  Finance Committee                                                               
should dictate  health and  social services  policy to  the House                                                               
Health and  Social Services Standing  Committee.  He  offered his                                                               
belief  that it  was the  fiduciary responsibility  of the  House                                                               
Finance Committee to ensure that the state operated effectively.                                                                
REPRESENTATIVE HAWKER, in response  to Co-Chair Herron, explained                                                               
that the committee process operated on  good faith and trust.  He                                                               
allowed that each  committee chairman had to decide  "what is the                                                               
right thing  to do."   He said  that the House  Finance Committee                                                               
would not  dictate human service  policy, but that, as  a sponsor                                                               
of  HB 26,  he would  attempt to  influence human  service policy                                                               
with  the  best  arguments.     He  observed  that  his  research                                                               
indicated  that a  permanent repeal  of the  sunset clause  would                                                               
facilitate  the implementation  of  the  program, with  providers                                                               
more willing to participate.                                                                                                    
3:25:19 PM                                                                                                                    
CO-CHAIR HERRON asked if Version E would change the fiscal note.                                                                
REPRESENTATIVE  HAWKER opined  that  the fiscal  note would  only                                                               
change at the sunset.                                                                                                           
3:26:11 PM                                                                                                                    
CO-CHAIR HERRON asked if  Representative Hawker preferred Version                                                               
E or HB 26.                                                                                                                     
REPRESENTATIVE  HAWKER  said  that  he  preferred  the  permanent                                                               
implementation of HB 26.                                                                                                        
3:27:20 PM                                                                                                                    
REPRESENTATIVE COGHILL asked  to clarify that Version  E had been                                                               
adopted.    He opined  that  once  a  Medicaid program  had  been                                                               
included, it would never be  retracted.  He expressed his support                                                               
for HB 26.                                                                                                                      
REPRESENTATIVE  HAWKER, in  response  to Representative  Coghill,                                                               
pointed out  that out of  control but well intended  programs had                                                               
been disciplined.                                                                                                               
REPRESENTATIVE  COGHILL, in  response  to Representative  Hawker,                                                               
noted that the legislature had  been reluctant to change Medicaid                                                               
services,  other  than  to  increase  them.    He  supported  the                                                               
preventative aspect of HB 26, and its positive economic impact.                                                                 
REPRESENTATIVE  CISSNA, in  response  to Representative  Coghill,                                                               
noted that  the most expensive  medevacs from the  Aleutians were                                                               
dental  related.    She  reported that  HB  26  had  preventative                                                               
aspects that were not usually included with Medicaid.                                                                           
3:33:29 PM                                                                                                                    
REPRESENTATIVE  HOLMES  opined that  the  sunset  clause was  not                                                               
necessary for HB 26, as  the Medicaid expenses would be routinely                                                               
3:35:17 PM                                                                                                                    
[Co-Chair Keller opened public testimony.]                                                                                      
3:35:23 PM                                                                                                                    
REGAN   MATTINGLY,  Alaska   Primary  Care   Association  (APCA),                                                               
explained that  the Alaska  Primary Care  Association represented                                                               
26 health  care organizations.   He said  that APCA  supported HB
26, as  oral health care  was critical, and that  dental services                                                               
reduced the future likelihood of  more expensive and acute dental                                                               
3:36:14 PM                                                                                                                    
DON ROBERTS said that dental care was necessary.                                                                                
3:38:16 PM                                                                                                                    
DELISA  CULPEPPER,  COO,  Alaska Mental  Health  Trust  Authority                                                               
(AMHTA);  Co-Chair, Alaska  Dental  Action  Coalition, said  that                                                               
AMHTA supported  a repeal of  the sunset clause, and  offered her                                                               
belief  that  it would  be  reviewed  as  a  part of  the  annual                                                               
Medicaid budget authorizations.                                                                                                 
3:40:30 PM                                                                                                                    
ELAINE  RATH,   Alaska  Brain  Injury  Network,   said  that  the                                                               
preventive dental services were utilized by seniors.                                                                            
3:41:45 PM                                                                                                                    
JON   SHERWOOD,  Medicaid   Special  Projects,   Office  of   the                                                               
Commissioner, Department  of Health  and Social  Services (DHSS),                                                               
said that the administration supported  the 5 year sunset clause,                                                               
as there was not yet conclusive data to the cost effectiveness.                                                                 
3:43:27 PM                                                                                                                    
BRAD WHISTLER,  Health Program Manager, Department  of Health and                                                               
Social  Services (DHSS),  reported that  good oral  health was  a                                                               
quality of  life issue, and  that it could affect  employment and                                                               
food choices.  He said  that coverage of preventative and routine                                                               
restorative   dental  services   had  precluded   more  expensive                                                               
replacement  costs.   He  explained  that  a dental  program  for                                                               
adults, along  with children, was  necessary for  a comprehensive                                                               
preventative  dental  program.    He  said  that  DHSS  supported                                                               
passage of some version of HB 26.                                                                                               
3:47:21 PM                                                                                                                    
REPRESENTATIVE SEATON  asked for  a comparison  to the  amount of                                                               
dental  facilities  expansion  and participation  both  with  and                                                               
without the 5 year sunset clause in HB 26.                                                                                      
MR.  WHISTLER explained  that the  2 year  sunset clause  did not                                                               
show  a commitment,  but that  re-authorization  of the  program,                                                               
even  with a  5  year  sunset clause,  reflected  a much  greater                                                               
assurance.   He  reported  that private  dentists were  concerned                                                               
with participation  in Medicaid  because of  reimbursement issues                                                               
and increases in federal audits.                                                                                                
3:49:19 PM                                                                                                                    
REPRESENTATIVE SEATON  asked about the result  should the program                                                               
exceed its allocated funding.                                                                                                   
MR. WHISTLER said  that it would result  in emergency regulations                                                               
to lower  the annual  recipient limit  for the  succeeding fiscal                                                               
3:51:11 PM                                                                                                                    
REPRESENTATIVE SEATON  asked if maintaining  a fiscal note  and a                                                               
sunset clause  determined this  dental program  to be  a separate                                                               
Medicaid program.                                                                                                               
MR.  SHERWOOD, in  response to  Representative Seaton,  explained                                                               
that   the  budgeting   for  this   as  part   of  the   Medicaid                                                               
appropriation was separate from the sunset clause.                                                                              
3:52:52 PM                                                                                                                    
MR. SHERWOOD, in  response to Co-Chair Keller,  said that seniors                                                               
were eligible  for Medicaid at  65, though some  individuals with                                                               
disabilities or low  income were eligible earlier.   He said that                                                               
Medicare did not include dental service.                                                                                        
3:54:01 PM                                                                                                                    
REPRESENTATIVE  SEATON asked  if the  dental therapists  in rural                                                               
Alaska were included in this program.                                                                                           
MR. WHISTLER replied that dental  therapists were included in the                                                               
tribal dental care program.                                                                                                     
3:55:30 PM                                                                                                                    
MARIE  DARLIN,  Coordinator,  American  Association  for  Retired                                                               
People  (AARP)  Capital  City  Task Force,  said  that  AARP  had                                                               
already written a letter in  support and that the continuation of                                                               
the program was important.                                                                                                      
3:56:43 PM                                                                                                                    
CO-CHAIR  KELLER  asked if  there  was  any more  testimony,  and                                                               
seeing none, public testimony was  closed.  He noted that Version                                                               
E would  be kept in front  of the committee, and  a determination                                                               
to move the bill would be made at a later date.                                                                                 
CO-CHAIR   HERRON  said   that  he   appreciated  the   sponsor's                                                               
discussion, and  that Version E  had been presented  to encourage                                                               
the debate.                                                                                                                     

Document Name Date/Time Subjects
DOC001.PDF HHSS 2/26/2009 3:00:00 PM
DOC002.PDF HHSS 2/26/2009 3:00:00 PM
HSS-HB2s.PDF HHSS 2/26/2009 3:00:00 PM
HB 2
HSS-HB2s2.PDF HHSS 2/26/2009 3:00:00 PM
HB 2