Legislature(2015 - 2016)CAPITOL 106

03/24/2016 03:00 PM House HEALTH & SOCIAL SERVICES

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03:03:36 PM Start
03:05:35 PM Presentation on Telehealth
04:04:12 PM HB344
04:31:24 PM HB315
05:16:36 PM HB328
07:13:45 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
NCSL: Telehealth
Heard & Held
<Bill Hearing Rescheduled to 3/29/16>
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved CSHB 344(HSS) Out of Committee
         HB 315-ELECTRONIC VISIT VERIFICATION: MEDICAID                                                                     
4:31:24 PM                                                                                                                    
CHAIR SEATON announced  that the next order of  business would be                                                               
HOUSE  BILL NO.  315, "An  Act  relating to  an electronic  visit                                                               
verification system  for providers of certain  medical assistance                                                               
4:31:43 PM                                                                                                                    
REPRESENTATIVE VAZQUEZ moved to adopt CSHB 315, Version 29-                                                                     
LS1287\E, Glover, 3/21/16, as the working document.                                                                             
REPRESENTATIVE STUTES objected                                                                                                  
4:32:18 PM                                                                                                                    
ANITA HALTERMAN, Staff, Representative Liz Vazquez, Alaska State                                                                
Legislature, read from prepared testimony as follows:                                                                           
     The most salient  points of this bill is  that the bill                                                                    
     protects  the most  vulnerable of  our population.   It                                                                    
     does so  by allowing an  alert to be triggered  for the                                                                    
     home and  community based provider agency  who then can                                                                    
     remediate this matter with a  beneficiary.  The goal of                                                                    
     HB 315 is to ensure  that the state only pays providers                                                                    
     for  the approved  services that  are  rendered by  the                                                                    
     appropriate home  health agency personnel  while within                                                                    
     that  recipient's  home  or other  authorized  setting.                                                                    
     Alaska's  population is  aging and  the demand  for PCA                                                                    
     and home  care services will increase.   Accordingly it                                                                    
     will continue to become  increasingly more important to                                                                    
     ensure  that the  home care  is delivered  properly and                                                                    
     that publically funded resources  are being managed and                                                                    
     spent  appropriately.   It is  anticipated that  Alaska                                                                    
     has  the potential  to realize  savings of  between $15                                                                    
     million and $35 million with this bill.                                                                                    
CHAIR SEATON asked how the anticipated savings are to be                                                                        
4:34:01 PM                                                                                                                    
MS. HALTERMAN  answered that she would  like to get a  little bit                                                               
more  background on  the bill,  there's been  a lot  of questions                                                               
about  the bill  that  have been  raised by  the  public and  the                                                               
Department of Health and Social Services.   She asked that she be                                                               
allowed to read notes written for the record, as follows:                                                                       
     House  Bill 315  is the  electronic visit  verification                                                                    
     Medicaid bill.   A 2012, the  Government Accountability                                                                    
     Office (GAO)  report has indicated  that 40  percent of                                                                    
     all  national   fraud  convictions  initiated   by  the                                                                    
     Medicaid  Fraud Control  Units (MFCUs)  are related  to                                                                    
     services that  are rendered in  the home  and community                                                                    
     based  settings.    According   to  the  institutes  of                                                                    
     Medicaid  ...  medicine  fraud ...  medical  fraud  and                                                                    
     abuse in  health care costs  $75 billion  annually, and                                                                    
     the cost  to unattended  patients can  be immeasurable.                                                                    
     It  has  been reported  that  the  adoption of  use  of                                                                    
     technology is  not only about  compliance, it  is about                                                                    
     survival.  Even FedEx deliveries  of a $4 item requires                                                                    
     an  electronic signature  proving  the  delivery.   Why                                                                    
     shouldn't  something as  valuable  as  patient care  be                                                                    
     electronically  documented and  verified?   Perspective                                                                    
     approaches to  combatting fraud, waste, and  abuse, are                                                                    
     far  more  effective  than  reactive  or  retrospective                                                                    
     approaches such  as audits  and imposing  new mandates.                                                                    
     To give  a little bit  of history, the State  of Alaska                                                                    
     has  previously   considered  using   electronic  visit                                                                    
     electronic verification systems.   On July 28, 2014, it                                                                    
     was reported by  the Anchorage or the ...  the ADN that                                                                    
     the  state  was  considering  a pilot  for  EVV.    The                                                                    
     Assistant Attorney  General at that time  reported that                                                                    
     Medicaid   fraud   was   costing  Alaska   Medicaid   a                                                                    
     conservative  estimate of  $45 million  per year.   EVV                                                                    
     systems  are  easy  to  use,  they  don't  require  any                                                                    
     installation  of software  or  hardware.   They  ensure                                                                    
     that  beneficiaries  receive   the  services  that  are                                                                    
     authorized for  the support that has  been approved and                                                                    
     for which the state is being  billed.  A person who can                                                                    
     use EVV, typically can use  the telephone.  EVV is used                                                                    
     for  compliance  and  for  quality  assurance  purposes                                                                    
     throughout  the nation.   Beneficiaries  are identified                                                                    
     by either a  landline or a GPS  location and caregivers                                                                    
     are identified by a unique  identifier, and a biometric                                                                    
     match that allows  the system to verify  that the calls                                                                    
     were   made  from   the   proper   caregiver  for   the                                                                    
     beneficiary.  EVV systems  authenticate the presence of                                                                    
     service providers,  they may  rely on  telephony, which                                                                    
     is the  most commonly used  form of EVV,  GPS tracking,                                                                    
     biometrics,  computers   for  the   provider  agencies,                                                                    
     mobile tablets,  tokens, or other applications  - those                                                                    
     names  of  devices  vary  by  vendor,  and  then  smart                                                                    
     phones.   An  individual  without  landline or  systems                                                                    
     used to authenticate services can  be provided a device                                                                    
     by a  vendor, kind of like  a pager.  This  generates a                                                                    
     client ID  with a ...  that provides a  digital readout                                                                    
     that can be given to the  caregiver who can call in and                                                                    
     then enter that  code into a system  about that client.                                                                    
     Our  research indicates  that  it  appears the  average                                                                    
     cost  of  ...  of that  verification  is  approximately                                                                    
     $0.15  per visit.   Biometrics  are critical  component                                                                    
     for  successful   EVV  implementation.     They  ensure                                                                    
     further  reduction  of  fraud,   waste,  and  abuse  by                                                                    
     identifying  that  caregiver's   identify.    Statewide                                                                    
     independent  approaches  involve vendor  solutions  and                                                                    
     are considered funded mandates.   These are cloud-based                                                                    
     platforms  that allow  for  remote patient  monitoring.                                                                    
     The states  that have  chosen the  statewide approaches                                                                    
     have done  so because  they want to  maintain oversight                                                                    
     over their EVV systems.   Statewide vendor solutions do                                                                    
     the following:  it allows the  state to  access federal                                                                    
     assistance  matching percentages  of up  to 90  percent                                                                    
     for frontend  system development; they gain  75 percent                                                                    
     for recurring  costs when the systems  are plugged into                                                                    
     the claims system; it removes  fraud liability from the                                                                    
     consumer  directed home  care  provider  agency and  it                                                                    
     places  it directly  on the  consumer  directed PCA  or                                                                    
     caregiver under  her consumer  directed clients.   This                                                                    
     morning  I  confirmed  with the  department  that  only                                                                    
     approximately  1.5 percent  of the  clients are  served                                                                    
     under  an  agency  based model,  so  this  would  limit                                                                    
     liability   from   any   of   our   consumer   directed                                                                    
     beneficiaries and their agencies.                                                                                          
4:39:13 PM                                                                                                                    
CHAIR SEATON asked for more explanation.                                                                                        
MS. HALTERMAN explained  there are two different  models, such as                                                               
an agency  based model  that typically  requires that  the agency                                                               
staff the  beneficiary's care  in that  home, and  sends someone,                                                               
typically a  CNA, to the home  to provide that care.   The agency                                                               
has some  direct responsibility over  directing the care  when it                                                               
is an  agency based caregiver.   When  it is a  consumer directed                                                               
PCA  model, the  consumer directly  hires, supervises,  and fires                                                               
their  caregivers,  they  provide  the  training,  and  they  are                                                               
responsible  for the  oversight  of their  care.   These  systems                                                               
place that responsibility  more directly on the  consumer and its                                                               
caregivers, rather than the agency, she said.                                                                                   
4:40:16 PM                                                                                                                    
MS. HALTERMAN continued reading her written testimony as                                                                        
     Statewide vendor  solutions can also be  set to trigger                                                                    
     an  alert so  that they  can  be sent  to the  provider                                                                    
     agency in  order for that  agency to investigate  a gap                                                                    
     in  care.   These can  be  set to  set an  alert to  an                                                                    
     administrator within the state  agency, but only if the                                                                    
     state chooses that option.   EVV systems can monitor to                                                                    
     ensure visits  are happening  as expected  and/or alert                                                                    
     that provider agency  when a gap in  care is occurring.                                                                    
     The  reports  and these  alerts  are  optional for  the                                                                    
     Department  of Health  and Social  Services.   Provider                                                                    
     agencies  maintain  all  control  over  scheduling  and                                                                    
     resolving any gaps in care  with that direct caregiver.                                                                    
     Generally, vendors provide training  and the use of the                                                                    
     EVV  systems  to   administrative  staff  within  those                                                                    
     agencies,  who  then  provide training  to  the  direct                                                                    
     caregiver.   EVV  systems statewide  allow for  con ...                                                                    
     configuration  of  new  software  so  EVV  systems  can                                                                    
     incorporate programs  specific business rules  for each                                                                    
     of  our  agencies.     They  ensure  for  comprehensive                                                                    
     training  to   be  consistently  provided,   which  may                                                                    
     include providing a training  kit, visual aids, videos,                                                                    
     or documentation  on best practices.   EVV  systems can                                                                    
     generate   reports  that   alert   agencies  when   the                                                                    
     caregiver  fails  to  show  up.   EVV  systems  can  be                                                                    
     integrated, again  with the existing  provider systems,                                                                    
     to minimize the impact on those provider agencies.                                                                         
     A  standards based  approach,  which  we've heard  some                                                                    
     folks  testify and  some ...  we've  seen some  written                                                                    
     testimony in support of.  Um,  I want to kind of define                                                                    
     the standards based approach.   It is an approach where                                                                    
     the  department sets  the minimum  set of  requirements                                                                    
     that  the provider  must meet  with the  use of  an EVV                                                                    
     system.  The  provider then needs to  ensure that those                                                                    
     requirements ... um, occur with  the solution that they                                                                    
     provide ...  or they procure  on their own.   Standards                                                                    
     based approaches  are unfunded  mandates.   States have                                                                    
     chosen those options  but those that have  done so have                                                                    
     experienced   that  they   have   little  control   and                                                                    
     oversight over their data.   The standards approach may                                                                    
     lead  to increased  reimbursement due  to the  cost and                                                                    
     complications  of  implementing  new systems  for  each                                                                    
     provider.   For  instance, the  State of  Washington we                                                                    
     have learned  has increased reimbursement  to providers                                                                    
     due  to   the  implementation  of  a   standards  based                                                                    
     recordkeeping system  or timekeeping system.   It's not                                                                    
     technically a  fully ... fully functioning  EVV system.                                                                    
     It   has  no   oversight   or   management  of   claims                                                                    
4:43:15 PM                                                                                                                    
MS. HALTERMAN continued reading her written testimony as                                                                        
     Standards based EVV systems do  not necessarily lead to                                                                    
     the  savings  that  are  found   in  the  vendor  based                                                                    
     solutions because the  provider still maintains control                                                                    
     and check the validity of all  of the data that is sent                                                                    
     to  the state.   There  is no  data sent  to the  state                                                                    
     independently  and; therefore,  no independence  of any                                                                    
     EVV  data.   Standards based  solutions may  become too                                                                    
     costly for  some of  our smaller  providers.   They may                                                                    
     become  far too  complicated for  smaller providers  to                                                                    
     implement.   Even our PCA Association  has pointed this                                                                    
     fact  out.    Our  fear  is  that  if  we  implement  a                                                                    
     standards based  solution this could cause  some of our                                                                    
     small  providers in  Alaska to  close  their doors  and                                                                    
     impede competition  due to an  unfunded mandate  of the                                                                    
     development  of  new  systems.    Standards  based  EVV                                                                    
     systems can  significantly slow  implementation because                                                                    
     if the state allows  for integration of standards based                                                                    
     EVV solutions  into existing business practices  it may                                                                    
     take  a  lot  longer  to  finish  full  implementation.                                                                    
     Standards based  EVV approaches can be  challenging for                                                                    
     some of our providers, it  can be complicated for those                                                                    
     providers.   They may delay the  full implementation or                                                                    
     cause non-compliance  for provider agencies  that can't                                                                    
     fully  implement.     They   may  reduce   the  savings                                                                    
     generated,  again  due to  the  lack  of oversight  and                                                                    
     control.   This is still essentially  a (indisc.) model                                                                    
     with  no upfront  fraud  prevention.   Standards  based                                                                    
     solutions place  the burden of verifying  or certifying                                                                    
     systems within  the State of  Alaska on  the department                                                                    
     in order  to assure that strong  technical controls are                                                                    
     placed  and maintained.   Requiring  the state  to make                                                                    
     exceptions  to address  the needs  of  remote or  small                                                                    
     providers as  has been suggested  by some, may  force a                                                                    
     vendor solution in  part to be considered  along with a                                                                    
     standards  based   solution  because   otherwise  small                                                                    
     providers may be forced to close their doors.                                                                              
4:45:34 PM                                                                                                                    
MS. HALTERMAN continued reading her written testimony as                                                                        
     So, I want to talk a  little bit about what EVV systems                                                                    
     do.  EVV systems can  do the following: they can reduce                                                                    
     inappropriate  billing  for  home health  and  personal                                                                    
     care    attendant    services;   they    can    improve                                                                    
     efficiencies; reduce  paid work  for both  the agencies                                                                    
     and the  State of Alaska's  Medicaid Agency.   They can                                                                    
     improve quality  by ensuring services are  provided for                                                                    
     the  most  vulnerable of  our  populations.   They  may                                                                    
     assist agencies  and providers  in helping  to identify                                                                    
     unmet  needs  or  missed   or  late  appointments  when                                                                    
     caregivers don't  show.  They  may improve  the ability                                                                    
     to make  adjustments to care  quickly by  triggering an                                                                    
     alert to an agency who  then knows the caregiver didn't                                                                    
     show up,  they can  initiate a backup  plan.   They can                                                                    
     improve policy decisions and  improve strategies due to                                                                    
     the ...  having access to  the encounter data  that the                                                                    
     state  has  never had  before.    It can  improve  data                                                                    
     collection,  evaluation,  and  also provide  a  unified                                                                    
     view of each  home and community based  and PCA service                                                                    
     that  will allow  care to  be examined  across multiple                                                                    
     agencies and  possibly multiple  provider types.   This                                                                    
     will  improve   the  quality  of  services   for  those                                                                    
     beneficiaries.     EVV  systems   can  afford   a  more                                                                    
     effective    invoice,    billing,    scheduling,    and                                                                    
     documentation of the service  delivery process and they                                                                    
     can  lead  to  enhanced  administrative  processes  for                                                                    
     those    agencies.       EVV   systems    capture   and                                                                    
     electronically submit  claims data with  accurate dates                                                                    
     from visits  that are verified  which allows  the state                                                                    
     to   validate  that   the  data   is  coming   from  an                                                                    
     independent source.  EVV systems  can ease reporting by                                                                    
     providing  a  central   location  that  identifies  the                                                                    
     support   and  services   that   those  providers   are                                                                    
     rendering.  EVV systems  can generate exception reports                                                                    
     that can  be run  ad hoc  ... um,  and they  can reduce                                                                    
     adult  protective  service  issues  and  the  need  for                                                                    
     investigations.   These reports may help  DHSS identify                                                                    
     concerns earlier than  they have been able to  do so in                                                                    
     the  past.    So,  the  benefits  of  EVV  include  the                                                                    
     potential  to eliminate  the padding  of timesheets  by                                                                    
     caregivers, it  allows for a  flag to  the supervisors,                                                                    
     the agencies  ... um,  to alert  to suspected  abuse or                                                                    
     neglect.  It  can reduce errors, it can  save money for                                                                    
     agencies and for the State  of Alaska.  If plugged into                                                                    
     the  claims   system  it  can  speed   up  payments  if                                                                    
     implemented  with that  claims system.   It  can ensure                                                                    
     compliance with state and federal  regulations.  It can                                                                    
     improve  quality  assurance  and  streamline  processes                                                                    
     including payroll for  many of our agencies.   They can                                                                    
     improve  efficiencies and  effectiveness.   And, lastly                                                                    
     save money on audits because  the proof of care will be                                                                    
     I  have  in  our  research, Rep.  Vazquez  and  I  have                                                                    
4:49:10 PM                                                                                                                    
REPRESENTATIVE  VAZQUEZ  interjected  that she  wanted  to  place                                                               
certain  relative  experiences  on  the record  and  offered  her                                                               
extensive  Medicaid  fraud background.    She  related that  many                                                               
states  have  been  using  electronic  visit  verification  (EVV)                                                               
systems for years, if not decades.   As a prosecutor she attended                                                               
numerous  national conferences  on  Medicaid fraud  and has  seen                                                               
demonstrations on  how these systems  work.  Currently,  there is                                                               
evidence that  these systems  can save  states money  by reducing                                                               
fraud, waste, and abuse, and add  to the quality of care that the                                                               
most vulnerable  of Alaska's population  needs.   Recent research                                                               
indicates that Congress  has gotten onto this idea,  and in 2015,                                                               
Representative  Steven Guthrie  introduced HR  2446, which  would                                                               
require  these   types  of  systems  for   every  state  offering                                                               
Medicaid, which is now all  50 states, and stipulates that states                                                               
that do  not implement the system  will be subject a  decrease of                                                               
Federal Medical Assistance Percentage  (FMAP), the federal share.                                                               
The most  recent action on this  bill was November 4,  2015, when                                                               
the bill was forwarded to the  subcommittee on Health to the full                                                               
Energy  and  Commerce  Committee.    In 2015,  on  the  House  of                                                               
Representatives  side   of  Congress,  Senator   Charles  "Chuck"                                                               
Grassley  introduced  SB  2416,  which  also  would  require  EVV                                                               
systems  in  Medicaid  and  in   addition  Medicare.    The  bill                                                               
stipulates that states  that do not implement will  be subject to                                                               
a decreased  federal share in  Medicaid, or FMAP.   She explained                                                               
that it's always  difficult, as a prosecutor who  also dealt with                                                               
civil cases,  to chase  after Medicaid  providers after  the fact                                                               
because it  very difficult once  the horse  has left the  barn to                                                               
recover money.  In 2015, there was  a PCA agency owner and it was                                                               
alleged  that $1.2  million were  billed  inappropriately to  the                                                               
Medicaid  program.   Restitution  was  ordered  by the  judge  at                                                               
judgement  but   recovering  $1.2   million  posed   a  difficult                                                               
challenge  for the  state.   This bill  in essence  would try  to                                                               
catch  the fraud,  waste,  and abuse,  upfront  before the  horse                                                               
leaves  the barn  and it  also adds  to the  quality of  care for                                                               
individuals, she explained.                                                                                                     
4:53:32 PM                                                                                                                    
MS. HALTERMAN  added that their  research identified a  number of                                                               
vendors that  provide this  service.  Sandata  is the  vendor the                                                               
sponsor's office  has been  working with  to crunch  numbers that                                                               
used  some data  from Kaiser  Family Foundation  from 2012.   She                                                               
pointed out that Sandata would  like to analyze more current data                                                               
and the  department has been  speaking with this vendor  and they                                                               
had a meeting  to share insights about these  systems, and answer                                                               
questions.   There are a number  of vendors such as,  First Data,                                                               
Vilify Health,  Access, Technology Solutions, and  Care Watch are                                                               
all EVV  vendors.  She explained  that it has been  made clear to                                                               
Sandata  that no  guarantee were  offered to  Sandata in  the RFP                                                               
process.   She said  that unfortunately, of  the 130  fraud cases                                                               
that have  been investigated by  Alaska's Medicaid  Fraud Control                                                               
Unit, 120  of them are  directly related to the  populations that                                                               
would be targeted with this bill.                                                                                               
MS.  HALTERMAN  referred  to Sandata's  Brian  Lawson's  previous                                                               
testimony and  said he is  willing to make himself  available for                                                               
anyone  with  further  questions   to  explain  the  benefits  of                                                               
analyzing real  data and the  return on investment found  from an                                                               
effective  implementation of  an EVV  system.   Although, Sandata                                                               
was not their  only research tool, it helped  develop the pricing                                                               
and return  on investment forecast  is collected from  the Kaiser                                                               
Family Foundation,  its 2012 data.   It  has been noted  that the                                                               
enrollment in populations in the  Medicaid expenditures are down,                                                               
but  only  PCA  data  was presented.    Ms.  Halterman  continued                                                               
reading her written testimony as follows:                                                                                       
     While the  return on investment  that was  generated by                                                                    
     Sandata includes not just  PCA, it identifies potential                                                                    
     savings for home  and community based waiver.   Now, in                                                                    
     the  targets that  they presented  on  that return  and                                                                    
     investment  because it  was not  using actual  Medicaid                                                                    
     data.   They would  need to have  access to  true data,                                                                    
     real  data, from  the  department, enrollments  numbers                                                                    
     and spending outcomes in order  to present a more valid                                                                    
     forecast of  what these savings  could be.  So  now the                                                                    
     current  data  does  show that  the  beneficiaries  and                                                                    
     spending are  down slightly for these  populations that                                                                    
     would be  targeted with  this bill.   It is  clear that                                                                    
     the  proper  implementation  of  an  EVV  system  would                                                                    
     provide a  significant return on  investment regardless                                                                    
     of  what the  numbers are,  regardless of  how much  is                                                                    
     spent.   The 5 percent  return on investment  was based                                                                    
     on  the PCA  and  home and  community based  population                                                                    
     savings  that use  an EVV  system.   And  the total  of                                                                    
     those expenditures was  approximately $305 million, the                                                                    
     numbers  again used  for the  analysis was  sample data                                                                    
     and   it  used   fail  information   that  the   vendor                                                                    
     identified from  a source that  was valid but  wasn't a                                                                    
     reliable  ...   necessarily  a  100   percent  reliable                                                                    
     source.  If  the department is willing  to provide more                                                                    
     reliable  data,  the  vendor   is  willing  to  analyze                                                                    
     current real  data to come  up with a  realistic return                                                                    
     on investment.   It should be noted  that while Sandata                                                                    
     did  present  a  return  on   investment  that  used  5                                                                    
     percent, 8  percent, and  12 percent  returns, Medicaid                                                                    
     Fraud  Control  unit  has alerted  us  that  those  are                                                                    
     conservative  estimates  because  they  have  presented                                                                    
     that fraud has  conservatively reached approximately 20                                                                    
     percent with those populations.   So sadly, in light of                                                                    
     the  testimony last  year in  Senate Finance  and House                                                                    
     Finance it  is clear that  Alaska has a  fraud problem.                                                                    
     Several documents...                                                                                                       
4:59:54 PM                                                                                                                    
REPRESENTATIVE  SEATON  interrupted  and  pointed  out  that  the                                                               
committee  actually wanted  a summary  of changes.   Before  each                                                               
member  is  HB 315,  with  a  proposal  to  take up  a  committee                                                               
substitute which is  different, he said.  The  committee wanted a                                                               
summary of those  changes which he opined that  one requires that                                                               
a  standards based  model  be used,  and Version  E  is that  the                                                               
department  shall  contract  with  the  vendor  to  implement  an                                                               
electronic visit  verification (EVV)  system.   Also, he  said it                                                               
required real time  reporting, to the extent feasible.   He asked                                                               
whether  the committee  has questions  on considering  the vendor                                                               
model versus the standard based model in the original bill.                                                                     
5:01:25 PM                                                                                                                    
REPRESENTATIVE TARR advised she does not have Version E.                                                                        
The committee took an at-ease from 5:01 p.m. to 5:05 p.m.                                                                       
5:05:23 PM                                                                                                                    
REPRESENTATIVE  WOOL  noted that  the  committee  heard from  the                                                               
vendors during the  last committee meeting and  asked whether the                                                               
committee has heard from the department.                                                                                        
5:06:29 PM                                                                                                                    
DEB   ETHERIDGE,  Deputy   Director,  Division   of  Senior   and                                                               
Disabilities Services, Department of  Health and Social Services,                                                               
said she is available.                                                                                                          
REPRESENTATIVE SEATON asked Ms.  Etheridge to discuss fiscal note                                                               
wherein  it lists  $224,000 each  year for  the next  five years;                                                               
however, in  the analysis, he  paraphrased the  following: "Three                                                               
states passed  legislation to  implement an  EVV program  and two                                                               
are fully implemented but that  they reported there was high cost                                                               
of  however  reported  initial cost  for  implementation  of  $13                                                               
million."  He remarked that he  is trying to relate that although                                                               
they have a larger population, but  it reads that "a timeline for                                                               
implementation be  24 months."   He pointed out that  this fiscal                                                               
note relates to Version A.                                                                                                      
5:07:47 PM                                                                                                                    
REPRESENTATIVE VAZQUEZ offered a  correction that the fiscal note                                                               
before the committee, OMB Component  Number 2663, states that the                                                               
total cost is $224,200, and it  would be 50 percent federal match                                                               
so the general fund match would be $112,100.                                                                                    
REPRESENTATIVE SEATON offered that it  is a recurring cost and he                                                               
is trying  to determine  how that  corresponds to  the narrative,                                                               
and he  paraphrased the following,  "that said in  several places                                                               
that the impacts were substantial.                                                                                              
5:08:55 PM                                                                                                                    
MS.  ETHERIDGE   responded  that  the  fiscal   note  before  the                                                               
committee is a  fiscal note to the  administrative component, and                                                               
it captures  the department's personnel costs  for implementation                                                               
and  ongoing compliance  and oversight  of  the electronic  visit                                                               
verification (EVV) system.  The  fiscal note was developed on the                                                               
original version and not on Version  E.  The other estimated cost                                                               
that the department struggled to  develop would have impacted the                                                               
Senior  and Disability  Services Medicaid  component and  at this                                                               
time  there  is not  an  indeterminate  Medicaid component  note.                                                               
However,  the  division   did  note  in  the   narrative  on  its                                                               
administrative  fiscal  note  that there  would  be  expenditures                                                               
impacting its Medicaid budget, and  it gave some logic about what                                                               
the division  anticipates or why  it had  difficulty anticipating                                                               
the cost associated with how it would impact Medicaid.                                                                          
REPRESENTATIVE  SEATON  surmised  that  was looking  at  one  GGU                                                               
Health Program Manager  II positions in Anchorage, and  it is the                                                               
main portion of the fiscal note.                                                                                                
MS.  ETHERIDGE  agreed  that  it  is  the  main  portion  of  the                                                               
administrative fiscal note.                                                                                                     
REPRESENTATIVE  SEATON  asked whether  Ms.  Etheridge  had had  a                                                               
chance to look at the vendor portion and generate a fiscal note.                                                                
MS. ETHERIDGE stated  that she had an opportunity  today to learn                                                               
more about the intention of  the implementation of the EVV system                                                               
and she  has a better  understanding of what the  obligations may                                                               
be and she is preparing a fiscal note.                                                                                          
REPRESENTATIVE SEATON added  that he just wanted  to clarify that                                                               
because there  is a single fiscal  note there, but that's  if the                                                               
department would do it and not  through the vendor model which is                                                               
Version E.                                                                                                                      
5:11:38 PM                                                                                                                    
REPRESENTATIVE TARR  offered that  due to  the recent  changes to                                                               
the PCA program, and also  the major Medicaid reform package that                                                               
is moving  through the legislature,  her concern is that  this is                                                               
potentially too many things at once.                                                                                            
MS. ETHERIDGE related that the  department does, and the Division                                                               
of Senior and Disability Services  has a number of initiatives in                                                               
which  it  is  working  on  currently  through  Medicaid  reform,                                                               
through  its  CMS compliance  necessary  for  the home  community                                                               
based services.   Which includes  the initiatives  the department                                                               
has  taken  to  streamline  and  have  more  oversight  over  its                                                               
personal care program.  She noted  that is part of the reason the                                                               
department  would  require  additional staff  to  implement  this                                                               
program, and the  department anticipates it will  take 24 months,                                                               
at least.                                                                                                                       
REPRESENTATIVE TARR  surmised that the changes  that affected the                                                               
amount of  time each recipient  is receiving, in part  to address                                                               
the issue of  potential fraud or misuse of the  time.  She opined                                                               
that in this particular instance,  some of the potential problems                                                               
may have been addressed through that process.                                                                                   
MS. ETHERIDGE  answered that the  division has made  some changes                                                               
to account for time for task,  and it allocates time and then the                                                               
recipient  receives  a  time  that is  authorized  weekly.    The                                                               
division  feels   like  it  has   oversight  and  a   more  clear                                                               
understanding of  the services it has  been authorizing; however,                                                               
it understands the  benefits of an EVV system as  it has explored                                                               
implementing that  system.  There  are some examples  of rounding                                                               
that may  happen that  it may  capture if it  was to  be directly                                                               
tied into  the division's enterprise  system so that  claims were                                                               
tied into the system so there  could be some efficiencies in that                                                               
way.   She advised that it  is difficult for the  division to say                                                               
what percent  of fraud would  be realized  at this time,  but she                                                               
has talked to other states and is trying to get a handle on it.                                                                 
5:14:24 PM                                                                                                                    
REPRESENTATIVE SEATON  reminded the committee that  the motion to                                                               
adopt Version E, a vendor system, is still on the table.                                                                        
5:14:33 PM                                                                                                                    
REPRESENTATIVE STUTES  removed her  objection to adopt  CSHB 315,                                                               
Version 29-LS1287\E,  Glover, 3/21/16,  as the  working document.                                                               
There being no objection, Version E was before the committee.                                                                   
CHAIR SEATON  asked Ms. Etheridge  to round out some  numbers for                                                               
Version E.                                                                                                                      
MS. ETHERIDGE agreed.                                                                                                           
[HB 315 was held over.]                                                                                                         

Document Name Date/Time Subjects
HB 344 proposed amendment_Seaton N.6.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB 344 Proposed amendment Seaton N 5.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB 344 Proposed amendemnt- SEaton N 3.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB328 Testimony_Kenai LIO_8 support_032216.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB328_Testimony_Kenai LIO_Opposition_032216.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB328 support_Mat-Su Health_March 22 2016.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 344 testimony_AMA_ proposed changes letter 3-10-16_UPDATED.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB 344 Testimony_Kristi Rice.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB 344 testimony Tanana Chiefs.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB 344 Testimony Joshua Sonkiss.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB315 proposed amendment E.1.pdf HHSS 3/24/2016 3:00:00 PM
HB 315
NCSL Telehealth presentation_March 24 2016.pdf HHSS 3/24/2016 3:00:00 PM
HB344 Letter to Rep Seaton_Holt.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB 328 - Supporting Document - Powerpoint Presentation.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 315 Fiscal Note -DHSS-SDSA-3.18.16-UPDATED.pdf HHSS 3/24/2016 3:00:00 PM
HB 315
HB328 Fiscal Note-DOT-NRHA-3.19.16.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB328 Fiscal Note DOT-SRHA-3.19.16.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB328 Fiscal Note-DOT-IASO-3.19.16.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB328 Fiscal Note - DOT-SEF-3.19.16.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB328 Fiscal Note -DOT-CRHA-3.19.06.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB328 Fiscal Note-DOT-MVO-3.19.16.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 328 amendment Wool.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB315 proposed CS_ver W.pdf HHSS 3/24/2016 3:00:00 PM
HB 315
HB 328 Opposition emails March 23.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 328 Opposition- 3.24 testimony_11 letters.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 328 Support_March 24 testimony_14 letters.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 328 Opposition-ALL testimony-39 individuals_3.21-3.26.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 328 Suppport-ALL testimony_74 individuals_3.21-3.26.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 328 Support 8 emails_March 23.pdf HHSS 3/24/2016 3:00:00 PM
HB 328