Legislature(2009 - 2010)CAPITOL 106

04/11/2009 03:00 PM HEALTH & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 50 LIMIT OVERTIME FOR REGISTERED NURSES TELECONFERENCED
Heard & Held
+ SB 13 MEDICAL ASSISTANCE ELIGIBILITY TELECONFERENCED
<Bill Hearing Canceled>
+ SB 32 MEDICAID:HOME/COMMUNITY BASED SERVICES TELECONFERENCED
Moved Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 223 TRAINING FOR PSYCHIATRIC TREATMENT STAFF TELECONFERENCED
Heard & Held
SB 32-MEDICAID:HOME/COMMUNITY BASED SERVICES                                                                                  
                                                                                                                                
3:09:55 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER announced that the  first order of business would                                                               
be CS  FOR SENATE BILL NO.  32(FIN), "An Act relating  to medical                                                               
assistance  payments for  home and  community-based services  and                                                               
provision of  personal care services  in a recipient's  home; and                                                               
providing for an effective date."                                                                                               
                                                                                                                                
3:10:21 PM                                                                                                                    
                                                                                                                                
MAX  HENSLEY,  Staff  to  Senator   Johnny  Ellis,  Alaska  State                                                               
Legislature,  explained that  SB 32  was a  collaborative effort.                                                               
He stated that home and community  based services were the key to                                                               
improving   the   quality   of   life   for   seniors   and   the                                                               
developmentally  disabled.   He  emphasized that  SB  32 was  not                                                               
intended to take  anything away from care  providers, but instead                                                               
to  create an  equitable and  predictable process.   He  observed                                                               
that home and  community based services were  less expensive than                                                               
institutional care.   He  pointed out that  long term  care costs                                                               
were a very large percentage  of projected Medicaid expenses.  He                                                               
stated that  most providers had  not seen an increase  to payment                                                               
structure since  2004.  He  explained that SB 32  gave Department                                                               
of Health and Social Services  (DHSS) the flexibility to devise a                                                               
cost based system  for all providers.  He  explained that Section                                                               
1 set  rates for home  and community  based services, as  well as                                                               
personal  care services.   He  shared that  it also  reviewed the                                                               
rates  of payment,  but he  emphasized that  nothing in  the bill                                                               
appropriated money for the future.   He explained that DHSS would                                                               
forward its cost proposal survey  of suggested rates, which would                                                               
become part of the budget process.   He noted that there would be                                                               
an annual  rate review, but  that the  cost survey would  only be                                                               
every four years.   He pointed out that the  inflation rate would                                                               
also be considered.                                                                                                             
                                                                                                                                
3:15:17 PM                                                                                                                    
                                                                                                                                
MR. HENSLEY directed  attention to Section 2,  and confirmed that                                                               
DHSS  would report  the trends  and the  elements in  established                                                               
payment rates.   He explained  that Section 3 repealed  Section 2                                                               
on June 30,  2014.  He pointed  out that Section 4  made the bill                                                               
effective on  July 1, 2011,  in order to  allow DHSS the  time to                                                               
develop the methodology.   He reviewed the fiscal  notes and said                                                               
that one was for three DHSS  positions, of which 50 percent would                                                               
be federally  funded.  He  explained that the second  fiscal note                                                               
was a projection  for the rate increases, in  anticipation of the                                                               
cost survey results.                                                                                                            
                                                                                                                                
3:18:19 PM                                                                                                                    
                                                                                                                                
JON   SHERWOOD,  Medicaid   Special  Projects,   Office  of   the                                                               
Commissioner, Department  of Health  and Social  Services (DHSS),                                                               
said that  the department had  worked with the sponsor,  and DHSS                                                               
was comfortable with the bill language.                                                                                         
                                                                                                                                
3:18:51 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER opened public testimony.                                                                                        
                                                                                                                                
3:19:02 PM                                                                                                                    
                                                                                                                                
MARIANNE MILLS,  President, AgeNet,  explained that AgeNet  was a                                                               
group of  25 statewide organizations  which provided  services in                                                               
the homes  of the elderly,  the community centers, and  the adult                                                               
day  facilities.    She  reported that  AgeNet,  along  with  the                                                               
Beneficiary  Boards   of  Alaska,  Alaska  Mental   Health  Trust                                                               
Authority  (AMHTA),  and  other  provider  groups,  had  declared                                                               
regular rate  reviews to be the  first priority.  She  noted that                                                               
this  coalition  had  met  with  Commissioner  Hogan  (DHSS)  and                                                               
Senator  Ellis.    She  offered  her support  for  SB  32.    She                                                               
expressed  that  the goal  of  the  coalition  was to  find  good                                                               
objective data for  the actual costs of home  and community based                                                               
services.   She  indicated that  this  would allow  for the  best                                                               
decisions.                                                                                                                      
                                                                                                                                
3:21:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   CISSNA  said   that  rate   reviews  were   very                                                               
important.   She asked if  this would study potential  care giver                                                               
positions, as well as existing ones.                                                                                            
                                                                                                                                
MR. HENSLEY  explained that  SB 32 covered  rate reviews  for the                                                               
service providers  listed under the four  current Alaska Medicaid                                                               
waivers, as  well as rate  reviews for the providers  of personal                                                               
care attendants.                                                                                                                
                                                                                                                                
3:22:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA  asked if  other potential  positions would                                                               
be covered.                                                                                                                     
                                                                                                                                
MR. HENSLEY replied that an  earlier study had reviewed a broader                                                               
group of  DHSS funded service  providers.  He clarified  that the                                                               
providers  referenced in  SB  32 were  currently  ready for  rate                                                               
reviews.   He agreed that  other care  givers may be  included in                                                               
future rate reviews.                                                                                                            
                                                                                                                                
3:23:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE CISSNA asked how long  this would take to put into                                                               
effect.                                                                                                                         
                                                                                                                                
MR. HENSLEY said that  the prior study was for a  year.  He noted                                                               
that DHSS requested 2 years to  develop the rate methodology.  He                                                               
reported the annual rate review would go into effect in FY2012.                                                                 
                                                                                                                                
3:24:23 PM                                                                                                                    
                                                                                                                                
STEVE LESKO,  President, KEY  Coalition of  Alaska, said  that it                                                               
was urgent to pass SB 32 right away.   He shared that the goal to                                                               
eliminate  the wait  list [for  services] was  restrained by  the                                                               
lack of  a rate review  process for  the community programs.   He                                                               
opined that  this had resulted  in difficulties for  the programs                                                               
with recruitment and  retention of staff.  He  noted that benefit                                                               
cuts, increases  in deductibles, and  the inability to  staff had                                                               
resulted  in a  lack of  service.   He cited  that the  community                                                               
programs did not  have equal access to the  rate increase reviews                                                               
which hospitals were allowed.  He  declared that this was a labor                                                               
intensive profession  with big challenges  to ensure  an adequate                                                               
workforce.   He stressed that  the health and safety  of Alaska's                                                               
most  vulnerable   citizens  was  the  paramount   concern.    He                                                               
emphasized that the KEY Coalition supported SB 32.                                                                              
                                                                                                                                
3:27:38 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER stated that he was a cross sponsor for SB 32.                                                                   
                                                                                                                                
3:27:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  COGHILL suggested  that the  rate review  and the                                                               
methodology review  should go hand  in hand.   He noted  that the                                                               
pressure to raise  rates would necessitate that  all were treated                                                               
fairly.                                                                                                                         
                                                                                                                                
3:29:58 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA agreed  that it  was necessary  to address                                                               
the work force issue immediately.                                                                                               
                                                                                                                                
3:30:25 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON posed that the  legislation should oblige DHSS to                                                               
implement the program in 2012.                                                                                                  
                                                                                                                                
MR. HENSLEY replied  that there was every reason  to believe that                                                               
DHSS would do  the required methodology work to  institute a cost                                                               
rate when the bill takes effect.                                                                                                
                                                                                                                                
3:31:22 PM                                                                                                                    
                                                                                                                                
MR.  SHERWOOD  asked that  DHSS  have  administrative support  in                                                               
order to  start in  two years.   He  declared that  the providers                                                               
were  not  prepared  to  submit  the  cost  reporting  which  the                                                               
department  needed  for  analysis.   He  explained  that  it  was                                                               
necessary to tell  the providers in advance  what information was                                                               
necessary,  and  then collect  and  analyze  the responses.    He                                                               
opined that DHSS  had the authority to move forward  prior to the                                                               
effective date of the bill.                                                                                                     
                                                                                                                                
3:33:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  COGHILL cautioned  to  be aware  of  the cost  to                                                               
providers for collecting information.                                                                                           
                                                                                                                                
MR.  SHERWOOD replied  that the  current language  allowed for  a                                                               
less burdensome cost survey for the providers.                                                                                  
                                                                                                                                
3:34:12 PM                                                                                                                    
                                                                                                                                
CO-CHAIR HERRON  moved to report  CSSB 32 (FIN) out  of committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
notes.   There  being no  objection, CSSB  32 (FIN)  was reported                                                               
from the House Health and Social Services Standing Committee.                                                                   
                                                                                                                                
3:34:40 PM                                                                                                                    
                                                                                                                                

Document Name Date/Time Subjects
50.PDF HHSS 4/11/2009 3:00:00 PM