Legislature(2009 - 2010)BUTROVICH 205

01/25/2010 01:30 PM HEALTH & SOCIAL SERVICES


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Audio Topic
01:30:16 PM Start
01:30:41 PM SB199
02:19:19 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ SB 199 MEDICAID COVERAGE FOR DENTURES TELECONFERENCED
Moved SB 199 Out of Committee
                                                                                                                              
             SB 199-MEDICAID COVERAGE FOR DENTURES                                                                          
                                                                                                                                
1:30:41 PM                                                                                                                    
CHAIR DAVIS announced consideration of SB199 and asked Senator                                                                  
Ellis to present the bill.                                                                                                      
                                                                                                                                
[Indisc. audio for much of Senator Ellis's introduction.]                                                                       
                                                                                                                                
1:31:15 PM                                                                                                                    
SENATOR ELLIS, sponsor of SB 199, thanked the committee for                                                                     
hearing the bill and introduced his aid, Max Hensley. He                                                                        
directed  the  committee's  attention  to  an  opinion  piece  he                                                               
authored  that  was published  in  The  Senior  Voice. In  it  he                                                             
related the striking story of an  elderly man who walked into his                                                               
office about  a year ago  and threatened to commit  suicide after                                                               
his interaction  with the Medicaid  adult dental office.  The man                                                               
had qualified for dentures under the  program but was told he had                                                               
to choose  between his upper  or lower  denture at that  time and                                                               
have  the other  denture installed  the following  year. He  felt                                                               
frustrated and humiliated and didn't know where to turn.                                                                        
                                                                                                                                
SENATOR ELLIS  reminded the  committee that  he supported  a bill                                                               
last year  to improve Medicaid  coverage for dental  health. When                                                               
the  bill came  before the  committee, he  agreed not  to include                                                               
this provision for  a two-year funding cycle in order  to move it                                                               
through  more  quickly,  but  vowed to  pursue  the  matter  this                                                               
session.                                                                                                                        
                                                                                                                                
1:34:15 PM                                                                                                                    
Allowing people  to receive a  full set  of dentures at  one time                                                               
will  improve patients'  oral  health and  reduce  the impact  on                                                               
Alaska's  dentists.  He  introduced members  of  Alaska's  dental                                                               
community,  Dr.   Dave  Logan  representing  the   Alaska  Dental                                                               
Society,  and  Dr.  Dirk  Menard calling  in  from  Fairbanks  on                                                               
teleconference,  and  noted  that the  member's  packets  contain                                                               
letters  of support  from a  wide variety  of providers.  Senator                                                               
Ellis was gratified  by the number of people who  came forward to                                                               
offer  their support  including AARP  Alaska, the  Alaska Primary                                                               
Care Association,  Alaska Public Health Association,  The State's                                                               
Joint Advocacy  Board's Commission on Aging,  Mental Health Trust                                                               
Authority,  Governor's   Council  on  Disabilities   and  Special                                                               
Education, The Advisory  Board on Alcoholism and  Drug Abuse, and                                                               
the Brain Injury Network.                                                                                                       
                                                                                                                                
SENATOR  ELLIS  continued;  this  bill allows  patients  who  are                                                               
eligible for dentures under the  Medicaid Adult Dental Program to                                                               
fund a complete  set of dentures. Current law  limits patients up                                                               
to $1150 in preventative or  restorative services per year, a cap                                                               
that was  designed to  cover one  half of a  set of  dentures. In                                                               
testimony before  this committee  in 2006,  the designers  of the                                                               
program stated their intention that  patients would receive their                                                               
uppers on June 30th and their lowers  on the first day of July in                                                               
the new fiscal year. That has  not proved to be practical for the                                                               
state, for the dentists, or  for the patients. Dental emergencies                                                               
cannot be scheduled around the  state's fiscal calendar; patients                                                               
are  suffering  and dentists  are  being  inconvenienced by  this                                                               
rule.  This  is the  kind  of  frustrating situation  that  gives                                                               
government and state agencies a bad name.                                                                                       
                                                                                                                                
SB 199  does not increase the  total amount of benefit  a patient                                                               
is  eligible  for,  but  allows patients  to  access  two  years'                                                               
benefit  in  a  single  fiscal  year  to  complete  a  relatively                                                               
expensive  procedure in  the most  medically  effective and  cost                                                               
effective   way,  so   everyone  benefits.   He  asked   for  the                                                               
committee's support in passing the bill.                                                                                        
                                                                                                                                
1:37:45 PM                                                                                                                    
MARIE DARLIN, Coordinator, Capital  City Task Force, AARP, Juneau                                                               
Alaska  added their  support  for this  very  important bill;  it                                                               
makes sense for clients and providers.                                                                                          
                                                                                                                                
1:38:43 PM                                                                                                                    
BRADLEY  WHISTLER,  Dental  Officer,  Department  of  Health  and                                                               
Social  Services  (DHSS),  said   the  department  likes  SB  199                                                               
conceptually. For adults needing an  upper and lower denture, the                                                               
services  would typically  be done  at  the same  time in  dental                                                               
offices. The department noted that,  with implementation of adult                                                               
preventive  and restorative  services  in  the Medicaid  program,                                                               
recipients might  time either  an upper or  lower denture  at the                                                               
end of  one fiscal year  and have the  other denture done  at the                                                               
beginning of the  next fiscal year. He is  aware of circumstances                                                               
in which  the timing  did not  work and patients  had to  wait an                                                               
extended period of time to get the opposing denture.                                                                            
                                                                                                                                
MR. WHISTLER  continued; if  the bill  is passed,  recipients and                                                               
dental providers will no longer  be required to provide the upper                                                               
and lower dentures  over a two-year period; they  will be allowed                                                               
to  utilize  the annual  limit  for  two  years to  complete  the                                                               
procedure.  The   department  has  heard  examples   of  patients                                                               
delaying  extractions when  they can't  get the  opposing denture                                                               
within the short  time period [that would allow them  to obtain a                                                               
full set  in one procedure],  which often leads  to complications                                                               
requiring  oral  surgery,  sometimes  with  sedation  or  general                                                               
anesthesia  costs.   However,  the   department  is   noting  the                                                               
likelihood of increased expenditures  for accelerating the annual                                                               
limit  in  proving these  services  and  is concerned  about  the                                                               
administrative costs  to implement  the program.  Dental services                                                               
and  the prior  authorization  process by  which  they track  the                                                               
annual  limit  are  both  based  on the  state  fiscal  year;  so                                                               
implementing  these   services  is  going  to   require  manually                                                               
tracking   recipients  who   have  received   the  services   and                                                               
accounting  for the  annual  limit over  the  two-year period  to                                                               
ensure they are not getting  additional services in the following                                                               
state fiscal year.                                                                                                              
                                                                                                                                
Because  of  these  concerns,  the department  is  not  taking  a                                                               
position  of  support or  opposition  to  SB 199.  Administrative                                                               
costs for  implementing the changes  reflected in the  bill could                                                               
be reduced by eliminating partial  dentures from the exception of                                                               
the $1150 annual  limit. The department will continue  to look at                                                               
the  cost of  the services  and try  to find  ways to  reduce the                                                               
administrative burden  for implementation,  but at this  time the                                                               
estimates are as outlined in the fiscal note for this bill.                                                                     
                                                                                                                                
1:41:27 PM                                                                                                                    
SENATOR DYSON asked how the state got into this situation.                                                                      
                                                                                                                                
MR.  WHISTLER replied  that when  this bill  was first  proposed,                                                               
they looked  at a  variety of  levels in  the annual  limit. What                                                               
drove the process was the  expenditure estimates for the bill and                                                               
the decision  to keep enough  in the limit  to cover an  upper or                                                               
lower  denture  within  one  fiscal year.  In  terms  of  timing,                                                               
especially in the first year  of the program, some clients didn't                                                               
get  services  in  time  to   get  one  denture  done  and  found                                                               
themselves  at the  beginning  of the  state  fiscal year  having                                                               
spent  the  entire benefit  and  having  to  wait a  year  before                                                               
getting the other denture.                                                                                                      
                                                                                                                                
1:42:41 PM                                                                                                                    
SENATOR  DYSON  said  he  suspected   that  all  dental  experts,                                                               
including Mr.  Whistler, would  agree that  having the  option to                                                               
get  both dentures  done at  the  same time  serves the  clients'                                                               
interests best.  He did not understand  how they ended up  with a                                                               
program that  is suboptimal for the  patient/clients just because                                                               
of administrative costs.                                                                                                        
                                                                                                                                
MR.  WHISTLER answered  that part  of the  decision was  based on                                                               
expenditures  for  the  program,   and  there  was  nothing  that                                                               
precluded  a  person from  getting  both  sets of  dentures;  the                                                               
Medicaid program just would not pay for it.                                                                                     
                                                                                                                                
1:43:44 PM                                                                                                                    
SENATOR DYSON  asked if he  was saying  that the way  the federal                                                               
program is administered is what drove the decision.                                                                             
                                                                                                                                
MR.  WHISTLER answered  no, that  all  of the  services in  these                                                               
programs are  optional services for  the state to provide,  so it                                                               
had nothing  to do with federal  law. It was an  effort to expand                                                               
services while controlling expenditures.  If they had been trying                                                               
to address  this situation  at the outset,  they would  have been                                                               
looking at an annual limit of $2300 or $2400.                                                                                   
                                                                                                                                
1:44:35 PM                                                                                                                    
SENATOR DYSON  prompted that they  might have looked at  the plan                                                               
Senator Ellis  has suggested, $2300  over two years,  a brilliant                                                               
solution  that should  net  out. The  senator  disclosed that  he                                                               
himself  is undergoing  some  reconstructive  dental work,  which                                                               
piqued  his interest  in this  issue. He  discovered that  dental                                                               
implants,  which  can  sometimes  prevent the  need  for  partial                                                               
plates, are not covered even  if the medical provider thinks that                                                               
is the best solution. He  also wondered whether the program would                                                               
allow a patient  to get the maximum annual  benefit available and                                                               
make  up  the difference  himself  in  order to  receive  optimal                                                               
treatment on any dental services.                                                                                               
                                                                                                                                
1:47:18 PM                                                                                                                    
MR.  WHISTLER  responded  that  in   terms  of  the  program  and                                                               
balancing  costs, they  looked  at  several possible  approaches:                                                               
make  a specific  appropriation for  these services  so they  are                                                               
monitored more carefully,  set an annual limit, and  look at what                                                               
services  they  will  cover.  They  decided  not  to  cover  some                                                               
services including  implants. They cover  periodontal maintenance                                                               
in terms of  scaling teeth but do not  cover periodontal surgery.                                                               
They will do a  root canal but do not pay for  surgery to cap the                                                               
end  of the  tooth. It  was a  balancing act,  deciding what  the                                                               
program would cover and what it would not.                                                                                      
                                                                                                                                
1:46:45 PM                                                                                                                    
SENATOR  DYSON persisted,  the  program will  pay  for a  bridge,                                                               
which would not  be required for an implant; why  not provide the                                                               
money  a bridge  would  have cost  and let  the  patient pay  the                                                               
balance for the more optimal service?                                                                                           
                                                                                                                                
MR.  WHISTLER  answered that  most  of  the Medicaid  program  is                                                               
managed by services  provided, so to provide just  an open annual                                                               
limit was  not an  approach that was  considered. He  pointed out                                                               
that  the  current annual  limit  would  not cover  a  three-unit                                                               
(complete)  bridge.   The  plan   was  to  expand   the  services                                                               
available,  which  were  fairly  limited in  the  adult  Medicaid                                                               
program,   and  move   toward  better   prevention  and   routine                                                               
restoration. They  anticipated that  there would  be a  co-pay by                                                               
recipients once they had exhausted their annual limit.                                                                          
                                                                                                                                
1:48:09 PM                                                                                                                    
SENATOR DYSON  said his  question was, why  not let  patients get                                                               
the benefit  of what the state  has agreed to pay  and then allow                                                               
them to pay any balance required to get a superior service.                                                                     
                                                                                                                                
MR. WHISTLER  replied that  he doesn't have  a better  answer for                                                               
that. It is  not an approach that was  considered in implementing                                                               
these  services. That  would  be basically  just  making a  fixed                                                               
dollar amount available to any client for dental services.                                                                      
                                                                                                                                
1:48:53 PM                                                                                                                    
JON  SHERWOOD,  Medical  Assistant Administrator,  Department  of                                                               
Health and  Social Services, explained that  the approach Senator                                                               
Dyson  described wouldn't  be allowed  under federal  law without                                                               
some kind  of waiver,  and when  they looked  at adding  a dental                                                               
option,  they didn't  consider that.  Under the  Medicaid program                                                               
they have  to define the procedures  they will cover and  pay the                                                               
cost of those procedures only. They  were allowed to set a dollar                                                               
limit on what  they would pay for dental services,  but even that                                                               
required clarification  from the  federal government.  They would                                                               
have to include  all of the services they want  to cover and just                                                               
set a  dollar limit, and  the belief at  the time was  that would                                                               
create a greater  demand for dental services than  was within the                                                               
target budget for the initial legislation.                                                                                      
                                                                                                                                
1:50:45 PM                                                                                                                    
SENATOR  THOMAS asked  why the  fiscal  note shows  no offset  in                                                               
2012.                                                                                                                           
                                                                                                                                
1:51:10 PM                                                                                                                    
MR.  WHISTLER said  denture expenditure  has  increased for  each                                                               
fiscal year the  program has been in place and  there would be an                                                               
acceleration  of expenditures  in the  first year  as people  got                                                               
both upper and  lower dentures. With new  individuals coming into                                                               
the program  every year, they did  not believe one year  would be                                                               
adequate to  fully meet  the unmet  demand for  denture services.                                                               
Also,  complete   dentures  generally  require   follow-up  work.                                                               
Partial  dentures are  often an  alternative to  doing crown  and                                                               
bridge work  and can  be less  expensive, so  he felt  they would                                                               
continue  to  see  more  partial dentures  in  the  program.  The                                                               
department expects to  see some offset in the  third fiscal year,                                                               
at which time the fiscal note will  drop down to zero in terms of                                                               
the denture expenditures in the program.                                                                                        
                                                                                                                                
1:52:17 PM                                                                                                                    
SENATOR THOMAS said he is  also concerned about the second fiscal                                                               
note. He  questioned whether they  had looked at  the possibility                                                               
of modifying the existing computer  program to assist in tracking                                                               
the amount of  annual benefit used and  patients' previous dental                                                               
history,  or whether  they are  in  some way  constrained by  the                                                               
federal government.                                                                                                             
                                                                                                                                
1:52:56 PM                                                                                                                    
MR.  WHISTLER  responded that  there  is  no federal  issue.  The                                                               
entire  claims processing  and tracking  system is  based on  the                                                               
state fiscal year.  Reprogramming the system for a  set of dental                                                               
services  that works  differently from  the rest  of the  program                                                               
would  probably  be  expensive.  He  deferred  to  John  Sherwood                                                               
regarding whether  they had  considered reprogramming  costs, and                                                               
said that,  at least at  the outset,  tracking would be  a manual                                                               
process.                                                                                                                        
                                                                                                                                
1:53:47 PM                                                                                                                    
MR. SHERWOOD  interjected that the  claims processing  system was                                                               
purchased in  1987 and was first  used in 1989. They  are looking                                                               
at ways to modify it but haven't  found any yet. It is old and is                                                               
not  a  relational  database,  so  changes  are  complicated  and                                                               
expensive, though they may be possible.  He said he will let them                                                               
know if they find solution, but  so far it appears this will have                                                               
to be done manually.                                                                                                            
                                                                                                                                
1:55:12 PM                                                                                                                    
SENATOR THOMAS referred to  previous discussions about electronic                                                               
versus  manual claims  and  problems  providers have  experienced                                                               
with  the filing  of  claims.  He opined  that,  if  this is  yet                                                               
another issue  with the system  in place, and  electronic records                                                               
are the  way of the  future, it  may be wise  to invest in  a new                                                               
system now. The legislature would like  to see it be as efficient                                                               
and accurate  a system as  possible. He suggested that  Dr. Logan                                                               
might be willing to comment on that.                                                                                            
                                                                                                                                
1:56:20 PM                                                                                                                    
SENATOR  PASKVAN asked  if the  numbers  in the  fiscal note  are                                                               
solely for dentures.                                                                                                            
                                                                                                                                
MR. WHISTLER answered yes.                                                                                                      
                                                                                                                                
SENATOR  PASKVAN  noted  that  the  expected  savings  in  travel                                                               
expense was not included.                                                                                                       
                                                                                                                                
MR. WHISTLER  referred to  his earlier  testimony that  there are                                                               
areas  of  potential  savings  to other  parts  of  the  Medicaid                                                               
program; one would  be transportation expenses. If  a second oral                                                               
surgery is  required, that would  be another source  of potential                                                               
savings  for the  program  as a  whole. Since  it  is a  separate                                                               
appropriation however,  those transportation savings would  be to                                                               
a different funding source in the Medicaid program.                                                                             
                                                                                                                                
1:57:28 PM                                                                                                                    
SENATOR  PASKVAN  asked  if  it  is  likely  that  transportation                                                               
services and emergency room expenses  would overwhelm the numbers                                                               
in the fiscal note.                                                                                                             
                                                                                                                                
MR.WHISTLER could  not speak  to that  level of  detail regarding                                                               
what is going on in the program.                                                                                                
                                                                                                                                
1:57:58 PM                                                                                                                    
DAVID  LOGAN  DDS,  The Alaska  Dental  Society,  Juneau  Alaska,                                                               
thanked  Senator  Ellis  and  those  on  the  committee  who  co-                                                               
sponsored this bill.  He said his only regret is  that the Alaska                                                               
Dental Society  didn't think of  it themselves; it is  an elegant                                                               
solution  to a  long-standing problem,  one that  is fair  to the                                                               
state, fair to the dental  providers and especially great for the                                                               
recipients. Dental  Medicaid providers  are frequently  placed in                                                               
the  uncomfortable position  of  helping a  patient decide  which                                                               
arch  they  are going  to  do,  upper or  lower  teeth.  It is  a                                                               
decision  he  hates  to  make.  The  patients  turn  to  him  for                                                               
guidance,  but often  the  patient  has either  no  teeth or  two                                                               
hopeless sets of dentition. It is not an easy decision to make.                                                                 
                                                                                                                                
2:00:05 PM                                                                                                                    
DR. LOGAN said, as a provider  in Southeast he also sees patients                                                               
from other communities, and the  travel costs are not small. This                                                               
is  a  multi-step  procedure   that  generally  requires  several                                                               
follow-up  visits;  by  time  a  person  flies  in  from  another                                                               
community and stays  at a hotel, the travel costs  dwarf the cost                                                               
of the procedure.                                                                                                               
                                                                                                                                
He  recounted  a  situation that  illustrates  the  problem  this                                                               
presents for  patients and providers.  A man was flown  to Juneau                                                               
from  Sitka; he  actually lived  in a  community in  the interior                                                               
that did not  have access to dental care. Dr.  Logan wrote to the                                                               
Medicaid division asking for authorization  to cover both sets in                                                               
one visit  and explained  that travel  costs would  ultimately be                                                               
more  than the  cost  of the  dentures. He  got  a response  from                                                               
Medicaid  saying that  their hands  were tied  under statute  and                                                               
they could pay for only one. He  asked his lab to provide a break                                                               
on the  second arch and  absorbed the additional cost  to provide                                                               
his patient with a full set of dentures.                                                                                        
                                                                                                                                
Addressing  Senator Thomas's  comments  about electronic  claims,                                                               
Dr. Logan  asserted that  they are  not the  wave of  the future;                                                               
they  are  here  now.  He  asked  whether  the  department  could                                                               
incorporate  this   into  the  new   computer  system   they  are                                                               
developing.  He also  agreed with  Senator Paskvan  regarding the                                                               
hidden  costs  they  see  with  dentures:  travel,  the  cost  of                                                               
retaining  hopeless teeth,  and  ER visits.  Dental  care is  not                                                               
inexpensive,  but a  single  ER visit  can cover  the  cost of  a                                                               
denture. Taking  all of that  into consideration, he  thinks they                                                               
could see cost savings in the first fiscal year.                                                                                
                                                                                                                                
2:03:48 PM                                                                                                                    
SENATOR ELLIS  thanked Dr. Logan  and stated that, based  on this                                                               
and other testimony  today, he is going to ask  the department to                                                               
reflect the  cost savings even if  it is not to  the same portion                                                               
of  the  budget.  It  is   clear  that  the  state  will  realize                                                               
significant savings if  this becomes law, so there has  got to be                                                               
some way to reflect that in the fiscal note.                                                                                    
                                                                                                                                
2:05:07 PM                                                                                                                    
DIRK MENARD,  DDS, said he simply  called to add his  support. It                                                               
makes sense  from a clinical and  a fiscal standpoint to  do both                                                               
sets of dentures at one time.  Many times his office will make an                                                               
upper set only  to find out next year it's  in the wrong position                                                               
to the lower set and they have to re-do the whole process.                                                                      
                                                                                                                                
2:05:59 PM                                                                                                                    
SENATOR ELLIS  asked if a  person can chew  food with one  set of                                                               
dentures.                                                                                                                       
                                                                                                                                
2:06:46 PM                                                                                                                    
MR.  MENARD said  not very  effectively. When  people lose  their                                                               
teeth, the second  set of dentures ends up holding  the first set                                                               
in. It also helps in articulating.                                                                                              
                                                                                                                                
2:07:59 PM                                                                                                                    
DENISE DANIELLO, Executive Director,  Alaska Commission on Aging,                                                               
Department of Health and Social  Services, said she believes this                                                               
bill  will help  to  improve  the health  and  wellness of  older                                                               
Alaskans.  The Commission  on Aging  has  supported the  Medicaid                                                               
dental program since it began  in 2006. The Medicaid Adult Dental                                                               
Program helps many low income seniors  who live with a variety of                                                               
painful and  destructive dental problems and  could not otherwise                                                               
afford routine visits or dentures.                                                                                              
                                                                                                                                
Studies  have shown  the  link between  oral  health and  chronic                                                               
disease. Older  adults are at  high risk for dental  decay, which                                                               
has   been  associated   with   periodontal  disease,   diabetes,                                                               
pneumonia,  and cardiovascular  disease.  The  inability to  chew                                                               
food  properly can  lead to  chronic malnutrition  and associated                                                               
problems.  Furthermore,  seniors  with  ill-fitting  dentures  or                                                               
missing  teeth may  avoid  opportunities  for social  engagement,                                                               
which  is  important to  maintaining  their  physical and  mental                                                               
health.                                                                                                                         
                                                                                                                                
MS.  DANIELLO  provided  some  data   based  on  Medicaid  claims                                                               
information on  seniors 65 years  of age and older.  It indicates                                                               
that  a total  of 3104  seniors  used the  Medicaid Adult  Dental                                                               
Program  between April  1, 2007  and December  31, 2009.  Of this                                                               
number,  1200  seniors  or 39  percent  received  dentures.  (She                                                               
pointed out  that this was  an unduplicated count.) The  Cost for                                                               
an  upper denture  was quoted  as $1085,  a lower  as $1125,  and                                                               
approximately $2225 for  a complete set of  dentures, which falls                                                               
just under the two-year cap of $2300.                                                                                           
                                                                                                                                
She stressed  that the  Alaska Commission  on Aging  supports the                                                               
bill   and   asked   that    the   legislature   consider   their                                                               
recommendations  for future  improvements to  the Adult  Medicaid                                                               
Program. They recommend allowing  eligible patients access to two                                                               
years' total  funding if they  receive partial dentures  and need                                                               
additional denture  services in  the same year.  Pending approval                                                               
of SB  199 and  its successful  implementation, they  believe the                                                               
legislature should  begin working  with the department  to expand                                                               
the two-year  access to  cover other  services that  are included                                                               
under  the Medicaid  Adult Dental  Program such  as root  canals,                                                               
crowns and even  dental exams. They also  believe the legislature                                                               
should consider  adjusting the  current cap, as  it has  not been                                                               
changed for at least three years.                                                                                               
                                                                                                                                
2:13:20 PM                                                                                                                    
CHAIR DAVIS  closed testimony on SB199.  She said this is  a good                                                               
piece of  legislation and it is  her intention to move  it out of                                                               
committee.  She asked  if there  are any  other comments  at this                                                               
time.                                                                                                                           
                                                                                                                                
2:14:19 PM                                                                                                                    
SENATOR PASKVAN  said, as he sees  it, the two issues  before the                                                               
committee  come down  to 1)  the offset,  which he  believes will                                                               
equal out  and 2) the  savings. When he  looks at the  savings in                                                               
travel, lodging and other medical  costs, he believes this is the                                                               
right answer at the right time. He likes the bill.                                                                              
                                                                                                                                
2:15:06 PM                                                                                                                    
SENATOR DYSON  pointed out that  the committee has  the authority                                                               
to alter the fiscal note and  there are excellent points in favor                                                               
of doing that.  He suggested that the committee do  that while it                                                               
is  in  their  purview  and   make  it  easier  for  the  Finance                                                               
Committee. He  does not want Finance  to have the easy  excuse of                                                               
what may be an over-stated fiscal  note to deny this. Part of the                                                               
fiscal  note anticipates  an increased  number of  people signing                                                               
up, which has nothing to do with  the bill, so the fiscal note is                                                               
misleading in at least one and possibly more than one point.                                                                    
                                                                                                                                
2:16:18 PM                                                                                                                    
CHAIR DAVIS thanked  Senator Dyson for his  statement. She thinks                                                               
some adjustments will be made,  perhaps in Finance, but said they                                                               
should let the Finance Committee do their job.                                                                                  
                                                                                                                                
2:16:46 PM                                                                                                                    
SENATOR ELLIS  added, with respect for  Senator Dyson's comments,                                                               
he wished  he were comfortable making  that change in a  way that                                                               
would not  offend the  people at Health  and Social  Services and                                                               
would  move them  further along.  He is  also uncomfortable  with                                                               
some of the numbers the department  put forward, but is sure this                                                               
is their  best effort and they  are still working on  it. He said                                                               
he has made a  request to the department to find  some way in the                                                               
fiscal note  to accommodate the  savings that common  sense tells                                                               
them will be  there, but he does not feel  qualified to make that                                                               
adjustment here. He does not  believe Finance would use this note                                                               
as an excuse not to hear the  bill and consider it and hopes they                                                               
can work together on it at that level.                                                                                          
                                                                                                                                
2:18:28 PM                                                                                                                    
VICE-CHAIR PASKVAN  moved to  report SB  199 from  committee with                                                               
individual  recommendations and  attached  fiscal note(s).  There                                                               
being no  objection, the  motion carried and  SB 199  passed from                                                               
committee.                                                                                                                      
                                                                                                                                
2:19:19 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair Davis adjourned the meeting at 2:19 p.m.                                                                                  

Document Name Date/Time Subjects
Scanned Bill 199.pdf SHSS 1/25/2010 1:30:00 PM