Legislature(2015 - 2016)CAPITOL 106

03/08/2016 03:00 PM House HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved CSHB 227(HSS) Out of Committee
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
                HB 227-MEDICAL ASSISTANCE REFORM                                                                            
3:06:23 PM                                                                                                                    
CHAIR SEATON announced that the  first order of business would be                                                               
HOUSE  BILL  NO. 227,  "An  Act  relating to  medical  assistance                                                               
reform  measures; relating  to  administrative  appeals of  civil                                                               
penalties  for  medical  assistance providers;  relating  to  the                                                               
duties of the Department of  Health and Social Services; relating                                                               
to audits  and civil penalties for  medical assistance providers;                                                               
relating to  medical assistance cost containment  measures by the                                                               
Department  of Health  and Social  Services; relating  to medical                                                               
assistance coverage  of clinic  and rehabilitative  services; and                                                               
providing for an effective date."                                                                                               
3:06:54 PM                                                                                                                    
REPRESENTATIVE  VAZQUEZ moved  to  adopt  the proposed  committee                                                               
substitute (CS) for HB 227,  labeled 29-LS1096\N, Glover, 3/7/16,                                                               
as the working draft.                                                                                                           
CHAIR SEATON objected for discussion.                                                                                           
3:07:55 PM                                                                                                                    
TANEEKA HANSEN,  Staff, Representative Paul Seaton,  Alaska State                                                               
Legislature,  explained   the  changes   made  in   the  proposed                                                               
committee  substitute,  from  the  document  titled  "Summary  of                                                               
Changes  Version H  to  Version  N HB  227  - Medical  Assistance                                                               
Reform."  [Included in members' packets.]                                                                                       
MS. HANSEN explained the changes to the bill title, which read:                                                                 
     Title:  On  line  6  the title  has  been  expanded  to                                                                    
     include  'federal   reimbursement  for   Alaska  Native                                                                    
     health services,' to reflect the new section 18.                                                                           
MS. HANSEN moved on to discuss the changes in Section 1, which                                                                  
     Section  1. Subsection  (2)(c) has  been  added to  the                                                                    
     legislative intent language.  Subsection (2)(c) directs                                                                    
     the  Department  of  Health   and  Social  Services  to                                                                    
     collaborate   with  clinics   and  centers   that  have                                                                    
     historically provided behavioral health services.                                                                          
MS. HANSEN explained the changes to Section 4, which read:                                                                      
     Section 4.  Language was placed back  into this section                                                                    
     to return  the number  of annual audits  required under                                                                    
     this  subsection  to  the current  statutory  level  of                                                                    
     0.75% of all  enrolled providers, with a  minimum of 75                                                                    
     audits a years.                                                                                                            
3:09:48 PM                                                                                                                    
MS. HANSEN directed attention to the changes in Section 5, which                                                                
     Section 5. New subsections (1)  and (2) have been added                                                                    
     to  AS 47.05.200(b)  to state  that the  department may                                                                    
     not assess interest on  overpayments under this section                                                                    
     if   a  provider   self  identifies   and  reports   an                                                                    
     overpayment  independent  of  an audit  and  repays  it                                                                    
     within five months of reporting.                                                                                           
3:10:53 PM                                                                                                                    
MS. HANSEN shared the changes in Section 6, which read:                                                                         
     New Section  6. A new section  6 has been added  to the                                                                    
     bill.  Section 6  adds subsection  (f) to  AS 47.05.200                                                                    
     allowing  the department  to  collaborate with  medical                                                                    
     assistance  providers  to create  educational  material                                                                    
     regarding  common   provider  errors   and  overpayment                                                                    
3:11:22 PM                                                                                                                    
MS. HANSEN pointed out the changes to the previous Section 11,                                                                  
which read:                                                                                                                     
     Previous  Section  11. deleted  Section  11  of HB  227                                                                    
     version H has been removed  from the bill. The language                                                                    
     originally  being removed  from  AS 47.07.036(b)  under                                                                    
     this  section  is  no  longer   in  conflict  with  new                                                                    
     sections and will remain in statute.                                                                                       
3:12:05 PM                                                                                                                    
MS. HANSEN described the changes in Section 12, which read:                                                                     
     Section  12.  Subsection  (d)(1) has  been  amended  to                                                                    
     change  the  target  population  for  the  1115  waiver                                                                    
     application  under  this  section  from  tribal  health                                                                    
     beneficiaries  to   recipients  of   behavioral  health                                                                    
     services.    Language  has been  added  to  subsections                                                                    
     (d)(2)  and  (3) to  state  that  the department  shall                                                                    
     design  the applications  for the  1915(1) and  1915(k)                                                                    
     options to  result in  cost savings  to the  state. The                                                                    
     term 'design'  has been deleted from  subsection (f) to                                                                    
     clarify  that the  department will  not be  required to                                                                    
     design  the  demonstration  project  implemented  under                                                                    
     this  section. Language  has been  added to  subsection                                                                    
     (g)  to  state  that   telemedicine  can  be  performed                                                                    
     between a  provider and a recipient  who are physically                                                                    
3:13:51 PM                                                                                                                    
MS. HANSEN moved on to discuss the changes in Section 15, which                                                                 
     Section  15. This  section has  been amended  to change                                                                    
     the   pre-term   birth   reduction   project   from   a                                                                    
     demonstration project conducted  by the department into                                                                    
     a  care coordination  pilot project  contracted with  a                                                                    
     third party.  The implementation date has  been changed                                                                    
     from January of  2017 to July. A report  on the success                                                                    
     of the pilot project is required after two years.                                                                          
3:14:45 PM                                                                                                                    
MS. HANSEN shared the changes in Section 17, which read:                                                                        
     Section  17.  The  date  of   the  report  required  by                                                                    
     subsection (c)  has been changed from  February 1, 2019                                                                    
     and will  now include  two separate reports.  The first                                                                    
     report is due  November 1, 2018, and the  second is due                                                                    
     November 1, 2019.                                                                                                          
3:16:02 PM                                                                                                                    
MS. HANSEN noted that a new Section 18 had been added, which                                                                    
     New section  18. A  new section has  been added  to the                                                                    
     uncodified law directing  the department to collaborate                                                                    
     with  Alaska   tribal  health  organizations   and  the                                                                    
     federal  government  to   fully  implement  changes  to                                                                    
     federal   policy  regarding   100%  reimbursement   for                                                                    
     American   Indian   and   Alaska   Native   recipients.                                                                    
     Collaboration may  include incentives for  providers to                                                                    
3:16:54 PM                                                                                                                    
MS. HANSEN concluded with the changes made to Section 22, which                                                                 
     Section  22. The  effective date  under subsection  (d)                                                                    
     has been updated  from January 1, 2017 to  July 1, 2017                                                                    
     to reflect the date change  in section 15 of this bill.                                                                    
     Other sections  have been  renumbered to  reflect these                                                                    
CHAIR  SEATON  directed  attention  to  the  chart  titled  "FY17                                                               
Governor's Amended  Budget to HB  227 Fiscal Notes"  [included in                                                               
members'  packets] which  detailed  a compilation  of the  annual                                                               
savings  to  unrestricted general  funds  (UGF)  from the  fiscal                                                               
notes, which was $223.2 million after six years.                                                                                
MS. HANSEN reminded  the committee that this  chart was generated                                                               
by the Legislative Finance Division  based on the fiscal notes to                                                               
the  original bill  version,  and not  on  the current  committee                                                               
substitute, Version N.                                                                                                          
CHAIR  SEATON noted  that  any revised  fiscal  notes would  also                                                               
include an updated chart.                                                                                                       
3:20:57 PM                                                                                                                    
CHAIR  SEATON, in  response to  Representative Stutes,  explained                                                               
that the chart incorporated the  federal match of 90 percent, and                                                               
reflected the savings incurred.                                                                                                 
REPRESENTATIVE  STUTES  clarified  that   the  chart  showed  the                                                               
decrease for the federal match during the upcoming years.                                                                       
MS.  HANSEN pointed  out  that  this was  a  compilation, with  a                                                               
different  format,  from  the  charts  presented  at  an  earlier                                                               
3:22:41 PM                                                                                                                    
The committee took an at-ease from 3:22 p.m. to 3:26 p.m.                                                                       
3:26:25 PM                                                                                                                    
CHAIR SEATON brought the committee back to order.                                                                               
REPRESENTATIVE VAZQUEZ  asked about  the fiscal note  labeled OMB                                                               
Component 2662.                                                                                                                 
3:28:25 PM                                                                                                                    
The committee took an at-ease from 3:28 p.m. to 3:31 p.m.                                                                       
3:31:12 PM                                                                                                                    
CHAIR SEATON brought the committee back to order.                                                                               
REPRESENTATIVE  VAZQUEZ  directed  attention  to page  3  of  the                                                               
fiscal  note labeled  OMB 2662,  and  asked about  the number  of                                                               
1915(c)  waiver  recipients  receiving  personal  care  attendant                                                               
(PCA) services and the general funds spent.                                                                                     
3:33:10 PM                                                                                                                    
JON  SHERWOOD,  Deputy  Commissioner, Medicaid  and  Health  Care                                                               
Policy, Department of Health and  Social Services, in response to                                                               
Representative  Vazquez, said  that there  were about  4,000, and                                                               
that he would report on the exact number.                                                                                       
REPRESENTATIVE  VAZQUEZ reflected  that the  1,603 recipients  on                                                               
1915(c)  waivers also  receiving  personal  care attendant  (PCA)                                                               
services, was just a portion of that total.                                                                                     
MR. SHERWOOD  replied that this  was correct.  He  explained that                                                               
the 1915(k) option  was only available to individuals  who met an                                                               
institutional  level  of  care.   He  stated  that  these  people                                                               
received home  and community based  services through  the 1915(c)                                                               
waiver, and as it was known  they met that institutional level of                                                               
care,  they could  be moved  into the  1915(k) for  personal care                                                               
services which had a higher [federal] match rate.                                                                               
REPRESENTATIVE  VAZQUEZ asked  if  there was  a study  indicating                                                               
this exactly, and not just departmental projections.                                                                            
MR. SHERWOOD offered his belief  that these numbers were directly                                                               
from the departmental records.                                                                                                  
REPRESENTATIVE  VAZQUEZ  questioned  whether the  1915(i)  waiver                                                               
would include individuals not currently receiving services.                                                                     
MR. SHERWOOD explained that the  waiver would include individuals                                                               
not  receiving  home and  community  based  services through  the                                                               
Medicaid   program,  although   it   was   expected  that   these                                                               
individuals would  be receiving  services through a  state funded                                                               
REPRESENTATIVE VAZQUEZ  suggested that there would  be additional                                                               
beneficiaries to the Medicaid program.                                                                                          
MR.  SHERWOOD  stated that  the  1915(i)  option did  not  expand                                                               
eligibility  for Medicaid,  it  expanded the  number of  services                                                               
available  to people  in the  Medicaid program.   He  pointed out                                                               
that  some   people  in  the  Medicaid   program  were  currently                                                               
receiving a  combination of Medicaid  and state  funded services,                                                               
and this  waiver would  move all the  services into  the Medicaid                                                               
REPRESENTATIVE   VAZQUEZ  mused   that  there   were  individuals                                                               
currently not  receiving any Medicaid  benefits who  would become                                                               
Medicaid beneficiaries.                                                                                                         
MR. SHERWOOD expressed agreement  that there were individuals who                                                               
did  not  currently receive  Medicaid  home  and community  based                                                               
services  benefits  who  would   become  beneficiaries  of  those                                                               
REPRESENTATIVE VAZQUEZ asked  if this was the same  for the other                                                               
MR. SHERWOOD asked to what other options she was referring.                                                                     
REPRESENTATIVE VAZQUEZ  suggested that  the 1915(k)  option would                                                               
expand services to existing Medicaid beneficiaries.                                                                             
MR. SHERWOOD expressed agreement.                                                                                               
REPRESENTATIVE  VAZQUEZ  asked  if  there  were  any  individuals                                                               
currently  not receiving  services through  the Medicaid  program                                                               
who would become eligible under the 1915(k) option.                                                                             
MR.  SHERWOOD replied  that  there were  not  any recipients  who                                                               
would  be  eligible  to receive  services  through  the  Medicaid                                                               
personal  care program  by adding  this option.   He  stated that                                                               
"generally speaking  this would not expand  eligibility or access                                                               
to service."                                                                                                                    
REPRESENTATIVE VAZQUEZ asked  if there were any  states which had                                                               
developed the (i) or (k) option.                                                                                                
MR.  SHERWOOD replied  that  about 20  states  had developed  the                                                               
1915(i)  option, and  about 4  states had  developed the  1915(k)                                                               
option to date.                                                                                                                 
REPRESENTATIVE VAZQUEZ asked for a list of those states.                                                                        
MR. SHERWOOD said that he did not remember which states.                                                                        
CHAIR SEATON pointed out to  Representative Vazquez that this had                                                               
been previously  discussed under the amendment  process using the                                                               
pie charts [included in members' packets].                                                                                      
3:39:31 PM                                                                                                                    
REPRESENTATIVE  VAZQUEZ stated  that  she had  not  been able  to                                                               
locate any states using either the 1915(i) or (k) options.                                                                      
MR. SHERWOOD said that he would provide the information.                                                                        
3:39:55 PM                                                                                                                    
REPRESENTATIVE  TALERICO,   addressing  the  same   fiscal  note,                                                               
labeled OMB  2662, asked for  clarification that  currently there                                                               
were  individuals for  whom the  state  paid 100  percent of  the                                                               
cost, and  that this option  would cut the  cost to the  state by                                                               
half, by offering a 50 percent federal match.                                                                                   
MR. SHERWOOD replied that this was correct.                                                                                     
3:41:24 PM                                                                                                                    
CHAIR  SEATON removed  his  objection.   There  being no  further                                                               
objection,  the proposed  committee substitute  (CS) for  HB 227,                                                               
labeled 29-LS1096\N,  Glover, 3/7/16, was adopted  as the working                                                               
3:41:38 PM                                                                                                                    
REPRESENTATIVE VAZQUEZ  expressed her objection to  the committee                                                               
substitute, Version  N.  She  said that, although this  was going                                                               
on the  right path, it would  take time to implement  these ideas                                                               
and that it was optimistic to  expect to see the savings "until a                                                               
year  down the  road."   She stated  that the  most disconcerting                                                               
part of the  bill was for the 1915(i) and  1915(k) provisions, as                                                               
they  would become  entitlement programs,  which the  state would                                                               
not be  able to terminate.   She  stated that the  current waiver                                                               
programs had more flexibility for caps  or limits.  She said that                                                               
using the 1915(i)  and 1915(k) options would not  allow the state                                                               
to  place  limits,  caps  or  waiting  lists,  and  could  create                                                               
financial  difficulty  in  upcoming  years if  the  state  fiscal                                                               
situation did  not improve.  She  noted that, if the  state fails                                                               
to comply,  all the federal  funding for Medicaid  programs could                                                               
be at risk.  She declared that  there were not any studies to the                                                               
costs of these  options, and she opined that "no  other state has                                                               
implemented these options."                                                                                                     
3:43:49 PM                                                                                                                    
REPRESENTATIVE  Foster  moved to  report  CSHB  227, labeled  29-                                                               
LS1096\N,  Glover,  3/7/16,  out  of  committee  with  individual                                                               
recommendations and the accompanying fiscal notes.                                                                              
3:44:48 PM                                                                                                                    
REPRESENTATIVE VAZQUEZ objected.                                                                                                
3:44:59 PM                                                                                                                    
REPRESENTATIVE TARR  complimented Representative Vazquez  for her                                                               
diligence and  that she would  continue to remain engaged  in the                                                               
process.   She stated her support  for the proposed bill  and the                                                               
opportunity to spend dollars for better outcomes.                                                                               
CHAIR  SEATON expressed  his  appreciation for  the  work by  the                                                               
committee, and he  opined that this would save  money and improve                                                               
health, which would mean longer term health savings.                                                                            
3:46:45 PM                                                                                                                    
REPRESENTATIVE  VAZQUEZ maintained  her  objection.   She  stated                                                               
that  these programs  were essential  to needy  people, and  they                                                               
provided a  safety net to  the most vulnerable populations.   She                                                               
expressed  her  interest in  the  long  term viability  of  these                                                               
programs, noting  that other  states had  limited programs.   She                                                               
offered an  example of one  state with a  two year wait  list for                                                               
any waiver  program.   She declared  that she  wanted to  see the                                                               
viability of  the program, as it  was a critical safety  net, and                                                               
that,  given that  Medicaid had  an annual  cost of  $1.7 billion                                                               
including  the federal  match, this  was a  serious matter.   She                                                               
acknowledged that  it was  a great  idea to  have more  access to                                                               
health care  and a healthier  population, but that the  state was                                                               
facing some difficult fiscal issues with  no "end in sight."  She                                                               
expressed  appreciation for  the effort  to maximize  the federal                                                               
match,  although  she  cautioned  restraint to  ensure  that  the                                                               
spending did not get out of control.                                                                                            
3:49:34 PM                                                                                                                    
A roll call vote was  taken.  Representatives Seaton, Tarr, Wool,                                                               
Talerico,  Stutes, and  Foster voted  in favor  of the  committee                                                               
substitute (CS) for HB 227,  labeled 29-LS1096\N, Glover, 3/7/16.                                                               
Representative  Vazquez  voted  against   it.    Therefore,  CSHB
227(HSS)  was  reported  out  of  the  House  Health  and  Social                                                               
Services Standing Committee by a vote of 6 yeas - 1 nay.                                                                        

Document Name Date/Time Subjects
HB 227 Summary of Changes_H to N.pdf HHSS 3/8/2016 3:00:00 PM
HB 227
HB 227 Proposed CS ver N_3.7.2016.pdf HHSS 3/8/2016 3:00:00 PM
HB 227
HB 344 Follow Up DCCED_3.8.2016.pdf HHSS 3/8/2016 3:00:00 PM
HHSS 3/10/2016 3:00:00 PM
HB 344
HB 227 Fiscal Note Graphs from Legislative finance_ 3-8-16.pdf HHSS 3/8/2016 3:00:00 PM
HB 227