Legislature(2017 - 2018)BUTROVICH 205

03/26/2018 01:30 PM Senate HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-- Testimony <Invited and Public> --
+ Bills Previously Heard/Scheduled: TELECONFERENCED
Moved CSSB 193(HSS) Out of Committee
Moved CSHB 215(FIN) Out of Committee
        HB 176-EMER. MEDICAL TRANSPORT SERVICE PAYMENTS                                                                     
1:42:17 PM                                                                                                                    
CHAIR  WILSON  announced  the  consideration  of  HB  176.  [CSHB
176(FIN) was before the committee.]                                                                                             
REPRESENTATIVE ADAM  WOOL, Alaska  State Legislature,  sponsor of                                                               
HB 176, said HB 176 is  an emergency medical transport bill which                                                               
allows  the  state  to  collect  additional  money  from  federal                                                               
Medicaid to more fully reimburse  the state for emergency medical                                                               
transport,  both ambulance  and air.  Currently fire  departments                                                               
and  emergency  medical  services  are  compensated  for  only  a                                                               
fraction  of  the  cost  associated  with  transporting  Medicaid                                                               
beneficiaries. This bill will allow  the Department of Health and                                                               
Social Services (DHSS)  to ask that the  federal government amend                                                               
Alaska's  Medicaid plan  to  include supplemental  reimbursements                                                               
for emergency medical transport.  The federal government approved                                                               
the  amended  plan; fire  departments  will  be  able to  get  50                                                               
percent of their  current uncompensated costs. If it  is a tribal                                                               
transport, the reimbursement is 100 percent.                                                                                    
1:46:40 PM                                                                                                                    
REPRESENTATIVE WOOL said the program  should take 12 to 18 months                                                               
to implement. The bill is  cost neutral to the state. California,                                                               
Washington, Missouri, Nevada, Texas,  and Florida have done this,                                                               
and programs  are pending in  other states. Last year  there were                                                               
21,000 claims  for ground transport  in Alaska. On  average, $800                                                               
was not  reimbursed for each  of these transports. That  total is                                                               
$17 million.  The state  would have netted  $8.5 million  if this                                                               
program had  been in  place last year.  For air  transport, there                                                               
were 281  claims. Those average $17,000  in unreimbursed Medicaid                                                               
costs. That  was $5 million  in unreimbursed costs. Of  that, the                                                               
state would  get half.  Last year the  state would  have received                                                               
$11 million additional dollars from  the Medicaid program if this                                                               
had been in place. There is  a slight administration cost that is                                                               
passed on to  the transport provider and  the federal government,                                                               
so the state incurs no cost at all for this program.                                                                            
1:48:12 PM                                                                                                                    
ROB  EARL,   Staff,  Representative   Adam  Wool,   Alaska  State                                                               
Legislature, reviewed the HB 176  flow chart in members' packets.                                                               
The flow chart  has four circles. The two  blue circles represent                                                               
DHSS. The  left circle,  DHSS-Regular State  Medicaid, represents                                                               
Medicaid as  it is reimbursed  now. The right blue  circle, DHSS-                                                               
Supplemental  Reimbursement,  represents  what  this  bill  would                                                               
accomplish.  The red  circle is  the medical  transport provider,                                                               
usually a fire department or  a municipality. The green circle is                                                               
the Centers for Medicare and Medicaid Services (CMS).                                                                           
He said the  flow chart has six arrows  with hypothetical numbers                                                               
to show the flow of money noted in the explanation below:                                                                       
     Explanation--Based  on   Hypothetical  $1000  Transport                                                                    
     The  Provider is  reimbursed $400  under regular  state                                                                    
     Medicaid  for a  $1000  transport. This  leaves a  $600                                                                    
     uncompensated  cost. Under  HB 176,  the Provider  then                                                                    
     sends $300 to DHSS  (Supplemental) and CMS matches with                                                                    
     the $300  federal share. DHSS  then sends $600  back to                                                                    
     the Provider.  The Provider recoups  $700 of  the $1000                                                                    
     Transport  Cost ($400  Regular  State  Medicaid +  $300                                                                    
     Federal  Share). Administrative  fees  (expected to  be                                                                    
     nominal)  will be  deducted from  the reimbursement  to                                                                    
     the Provider.                                                                                                              
SENATOR VON IMHOF said some of  this depends on timing. If $1,000                                                               
is spent  on the transport,  there is  a delay getting  $400 from                                                               
Medicaid. At  the same time $300  is going to the  state in order                                                               
to get  the match.  The provider  could be  out $1,300  until the                                                               
money comes  back. She asked if  the bill addresses timing  or if                                                               
it is up to the cash flow of the provider.                                                                                      
1:51:37 PM                                                                                                                    
REPRESENTATIVE WOOL  said the provider  would have some  money in                                                               
their  cash account.  As they  submit  to Medicaid  for the  $400                                                               
reimbursement,  they could  simultaneously send  $300 to  DHSS to                                                               
start the federal  process going. He does not know  if they would                                                               
wait for  Medicaid reimbursement  before submitting the  $300. He                                                               
said  Rich Etheridge,  the Juneau  Fire Chief,  might be  able to                                                               
answer that.                                                                                                                    
SENATOR VON IMHOF  asked what the net savings is  to the state vs                                                               
the cost to the  state. She said she wanted to  make sure she was                                                               
reading the two  fiscal notes correctly. The first  one from DHSS                                                               
Appropriation:   Health   Care  Services,   Allocation:   Medical                                                               
Assistance Administration,  is a  person to help  administer this                                                               
at about $116,000. The next  page is DHSS Appropriation: Medicaid                                                               
Services, Allocation:  Health Care  Medicaid Services.  She asked                                                               
how to read that fiscal note.                                                                                                   
1:53:51 PM                                                                                                                    
MR.  EARL said  that for  the  first fiscal  note, OMB  Component                                                               
Number  2077, the  $11.1 million  under the  fund sources  is the                                                               
federal  receipts. That  is the  amount of  money going  from the                                                               
green  circle, the  Centers for  Medicare  and Medicaid  Services                                                               
(CMS), back to the department.  This is the Medicaid supplemental                                                               
reimbursement amount  the state providers will  be receiving. The                                                               
$10.7  million is  the  amount  the provider  is  sending to  the                                                               
department and  then receiving back.  That money  is pass-through                                                               
money. The  other fiscal note,  OMB Component Number 242,  is the                                                               
cost for the  state to run the program, but  the cost is entirely                                                               
borne by  the provider at  50 percent and the  federal government                                                               
at 50 percent. That  is seen on page 3 of  the first fiscal note,                                                               
number 2077.                                                                                                                    
SENATOR  VON IMHOF  summarized that  in  FY 2020  the state  will                                                               
receive $11.167  million from the  federal government  under this                                                               
program.  The state  will  take receipt  of  $10.73 million  from                                                               
providers  throughout  the year  and  then  the state  will  turn                                                               
around and pay providers $21.898 million.                                                                                       
REPRESENTATIVE  WOOL  said that  is  correct.  The providers  pay                                                               
$10.7 million  and receive $21.8  million. They are paying  10 to                                                               
get 20, in  a sense. They have  to put up half and  they get back                                                               
the full payment.                                                                                                               
CHAIR WILSON  said the  local municipalities  are putting  up the                                                               
state's 50 percent to get the federal match.                                                                                    
1:57:09 PM                                                                                                                    
REPRESENTATIVE WOOL  said this concept  is a little  confusing in                                                               
that the state  portion is paid by the provider,  the state holds                                                               
on to  the half, they bill  out the federal government,  they get                                                               
the other  half back,  and they  give both  halves back.  He said                                                               
it's awkward, but it's how the system works.                                                                                    
SENATOR  BEGICH  asked  if  the  provider in  all  cases  is  the                                                               
municipal  government  or  if  it  will  be  public  and  private                                                               
MR.  EARL  said  it  is   available  only  to  government  public                                                               
SENATOR BEGICH said instead of  the state paying the $10 million,                                                               
the local governments are paying the  $10 million and that is how                                                               
the Medicaid match is triggered.                                                                                                
REPRESENTATIVE WOOL  said that in  the past the state  never paid                                                               
the money and  therefore the state was never  received the money.                                                               
The  loss  was   incurred  by  the  provider,   either  the  fire                                                               
department  or municipal  government.  This is  trying to  recoup                                                               
some  of these  costs. Other  states  are doing  this and  Alaska                                                               
wants  to take  advantage  of  it. The  state  wasn't losing  the                                                               
money. The municipal governments were not getting compensated.                                                                  
SENATOR BEGICH said  there are proposals to cut back  some of the                                                               
federal Medicaid funding. Every time  a Medicaid bill has come to                                                               
the committee  he has asked what  the impact would be  to the law                                                               
if the federal Medicaid was cut back.                                                                                           
REPRESENTATIVE WOOL  said if the  funding goes away,  the program                                                               
goes away.  There is no liability  to the state. It  doesn't cost                                                               
anything to implement  the plan and it doesn't cost  any money if                                                               
it goes away.                                                                                                                   
2:00:03 PM                                                                                                                    
SENATOR  GIESSEL said  Moose Pass  and Cooper  Landing both  have                                                               
volunteer fire  departments and  emergency responders.  She asked                                                               
how they would fit into this.                                                                                                   
REPRESENTATIVE WOOL said  the community of Fairbanks  has many of                                                               
those as  well. The municipality handles  the money disbursement.                                                               
In the end, the money DHSS gets goes to the municipality.                                                                       
SENATOR GIESSEL said Senator Micciche  pointed out that the Kenai                                                               
Peninsula Borough would be the billing mechanism.                                                                               
SENATOR MICCICHE asked, using the  example of the $1,000, instead                                                               
of  the fire  department  receiving $400,  by  going through  the                                                               
state, they  get the federal  match billed through the  state for                                                               
300 additional dollars.                                                                                                         
MR. EARL responded yes.                                                                                                         
SENATOR MICCICHE added that that is  at no additional cost to the                                                               
MR. EARL responded yes.                                                                                                         
SENATOR  VON  IMHOF  asked  if  a  private  carrier  like  Alaska                                                               
Airlines could be compensated under the program.                                                                                
2:02:13 PM                                                                                                                    
MR. EARL  said contractors can  be compensated under  the program                                                               
if they have no direct relationship with Medicaid.                                                                              
SENATOR   MICCICHE   asked   if   there  is   any   interest   in                                                               
municipalities sharing  the cost  of the  position that  would be                                                               
the  only cost  to the  state, the  $116,000 the  first year  and                                                               
$109,000 afterwards.                                                                                                            
MR. EARL said  the bill is zero cost to  the state. The providers                                                               
will  pay half  and the  federal  government will  pay the  other                                                               
SENATOR  MICCICHE said  so the  interagency receipts  of $116,000                                                               
for the  position is paid  the same way  as the other  funding is                                                               
paid with the match.                                                                                                            
MR. EARL deferred the question to DHSS.                                                                                         
CHAIR WILSON said if the state  is taking off a percentage of the                                                               
fees coming  back that can  be more  cost neutral for  the state.                                                               
This is  a huge concern for  people in the Mat-Su  who have asked                                                               
about this for  a couple of years. He said  he likes the concept,                                                               
but  wants to  make sure  it is  more of  a cost  neutral to  the                                                               
SENATOR MICCICHE  said if  OMB Component  Number 242  is correct,                                                               
the reason it is interagency is  that the fees would be collected                                                               
from providers  who participate in  the program  via reimbursable                                                               
services agreement.                                                                                                             
He asked Ms.  Brodie, using the $1,000 example,  whether the bill                                                               
allows the  state to bill  Medicaid the $300  that municipalities                                                               
cannot  bill Medicaid  for  and  then provide  that  $300 to  the                                                               
2:05:37 PM                                                                                                                    
MARGARET  BRODIE, Director,  Division  of  Health Care  Services,                                                               
Department of  Health and  Social Services  (DHSS), said  that is                                                               
correct.  Municipalities would  be  providing the  match for  the                                                               
state to draw down the federal $300.                                                                                            
SENATOR  MICCICHE clarified  that  in fiscal  note OMB  Component                                                               
Number 242,  the cost of  the position  will be funded  from fees                                                               
collected  from   providers,  which   he  assumes  is   also  the                                                               
municipalities, through a reimbursable services agreement.                                                                      
MS. BRODIE  said correct, that  funding would be provided  at the                                                               
same time as the other match.                                                                                                   
2:06:21 PM                                                                                                                    
SENATOR  VON IMHOF  asked if  a private  carrier can  qualify for                                                               
MS. BRODIE said not unless  they are associated with a government                                                               
SENATOR  VON  IMHOF asked  if  there  are private  carriers  that                                                               
provide transport in Alaska.                                                                                                    
MS. BRODIE said yes.                                                                                                            
SENATOR BEGICH  asked if  the relationship  she is  describing is                                                               
when a private carrier has a contract with government.                                                                          
MS. BRODIE  said yes,  the government entity  would have  to bill                                                               
SENATOR  BEGICH  asked  for clarification  that  if  the  private                                                               
carrier  had  a  contract  with a  local  government,  the  local                                                               
government could compensate the private entity.                                                                                 
MS. BRODIE said  that would be up to the  contract they have with                                                               
a municipality.                                                                                                                 
2:08:24 PM                                                                                                                    
SENATOR  MICCICHE  asked  if  she  could  give  the  committee  a                                                               
hypothetical of  the government owned Central  Peninsula Hospital                                                               
that  has a  case that  has to  be airlifted  to Anchorage.  That                                                               
private company  could bill through  the Kenai  Peninsula Borough                                                               
to the state  and the state would apply for  the additional match                                                               
at no cost  to the state. It's that there  is an additional match                                                               
available  for the  local governmental  body that  has contracted                                                               
with that carrier.                                                                                                              
MS. BRODIE  said if  they had a  contract with  Central Peninsula                                                               
Hospital, that is correct.                                                                                                      
2:09:24 PM                                                                                                                    
JEFF  TUCKER, President,  Alaska Fire  Chief's Association,  Fire                                                               
Chief, supported HB  176. He said this program  falls under Title                                                               
19 of the  Social Security Act. Several states  have enacted this                                                               
program.  It has  been available  for years,  but Alaska  has not                                                               
taken advantage  of it. This  bill is  the first step  for Alaska                                                               
emergency  medical services  (EMS) providers  to be  eligible for                                                               
this federal reimbursement. Providers only  get a fraction of the                                                               
cost  right now  for ambulance  services for  Medicaid transport.                                                               
Thirty-one percent  of the  patients transported  by the  City of                                                               
Kenai are  Medicaid patients. The percentages  are similar across                                                               
the state.  There is no cost  to the state for  this program. The                                                               
reimbursement dollars  will pay for  the program. The  program is                                                               
optional for each community.                                                                                                    
He said  the federal dollars  are for expenses  already incurred.                                                               
The local taxpayers are supplementing  federal government for the                                                               
cost of  that transport. They  are already paying taxes  for that                                                               
federal government  program. There is  no impact to  the existing                                                               
Medicaid program. These funds come  back to the EMS department to                                                               
continue to provide care for  the patients they transport. HB 176                                                               
has  a   real  impact  to  communities   that  provide  ambulance                                                               
He said  the City of  Kenai is  looking at $200,000  in potential                                                               
reimbursements for  this program, which  is not a small  sum. One                                                               
of   the  questions   was  about   timing   of  collections   and                                                               
submissions. As the program is  set up, the municipality can plan                                                               
submissions, either  yearly or quarterly,  for example. It  is an                                                               
easy way for the communities to budget and plan for the program.                                                                
2:13:27 PM                                                                                                                    
SENATOR   VON  IMHOF   said   one  of   her   concerns  is   that                                                               
municipalities may  expand their EMS departments  with this extra                                                               
money. If  this program goes away,  they will have to  go through                                                               
the  painful  process  of   decreasing  the  department.  Another                                                               
thought is whether this additional  money will offset local taxes                                                               
and provide fiscal relief to local taxpayers.                                                                                   
MR. TUCKER  said that would be  up to the municipality  or agency                                                               
collecting funds.  The funds collected  through this  program are                                                               
to fund  EMS programs. As  to the  question of whether  they will                                                               
expand,  hopefully municipalities  will  take into  consideration                                                               
that the  program may  not last forever.  This is  an entitlement                                                               
program separate  from other programs.  There is no sign  that it                                                               
will go away.                                                                                                                   
SENATOR  MICCICHE asked  if his  billing  agency is  the City  of                                                               
MR. TUCKER said yes.                                                                                                            
SENATOR  MICCICHE  asked  whether private  insured,  non-Medicaid                                                               
eligible  and  non-Medicaid  charity  care  would  not  become  a                                                               
liability to  the state. That would  stay the same as  it is. The                                                               
state  would secure  the additional  match for  Medicaid-eligible                                                               
billing for his EMS department.                                                                                                 
MR. TUCKER said that is correct.                                                                                                
2:15:53 PM                                                                                                                    
SENATOR  GIESSEL asked,  assuming  your EMS  fire department  got                                                               
$200,000 back, if that money would be used to upgrade equipment.                                                                
MR. TUCKER  responded that  it would be  up to  the municipality.                                                               
Those grant-funded  programs, the Code  Blue Project that  she is                                                               
referring  to, are  vital to  the state,  especially smaller  EMS                                                               
programs. This program will assist  in providing services, but it                                                               
will not offset  the total needs for the community.  It helps get                                                               
back  to square  one  for their  reimbursed  costs for  providing                                                               
those services.                                                                                                                 
SENATOR MICCICHE asked why it has  taken so long to discover this                                                               
2:17:45 PM                                                                                                                    
MR. TUCKER  said his understanding  is that the program  has been                                                               
on the books  for 30 years. Fire chiefs  in California discovered                                                               
that the language  was in the federal  regulation. California was                                                               
the first state  to enact this legislation and  it spread through                                                               
the western  states. For Alaska  to get this  reimbursement takes                                                               
legislation and then  going through the process  with the federal                                                               
program.  He wishes  they had  known about  the program  20 years                                                               
ago,  but they  didn't. Hopefully  they can  take advantage  of a                                                               
program they have been paying for as federal taxpayers.                                                                         
RICH ETHERIDGE, Representative,  Alaska Fire Chief's Association,                                                               
Fire  Chief,  supported   HB  176.  He  said   the  Fire  Chief's                                                               
Association represents over 100 fire  departments from one end of                                                               
the state  to the other. This  is their highest priority.  HB 176                                                               
provides desperately  needed relief to departments.  The call for                                                               
medical services  is climbing  drastically. Juneau  has had  a 26                                                               
percent  increase  in call  volume  in  three years.  They  don't                                                               
receive any  additional funds based on  that. Twenty-five percent                                                               
of  their medical  transports are  Medicaid patients.  As in  the                                                               
example given, for  $1,000 in costs they get $400  back. The rest                                                               
of the  money is borne by  taxpayers locally. They will  get back                                                               
half of  the money  that taxpayers are  already paying.  The cost                                                               
recovery is not for the entire cost, but it helps quite a bit.                                                                  
2:20:42 PM                                                                                                                    
He said  Juneau is short  staffed for ambulances. This  could put                                                               
another  ambulance  on the  road  to  help  reduce the  wait  for                                                               
medical  care.  Regarding  the question  about  private  entities                                                               
being able  to benefit  from this  program, the  local helicopter                                                               
companies bill the city, not  the patients. Because they bill the                                                               
city, that  is part of the  cost of the city  providing services.                                                               
It  is  an  amazing  program.   The  fire  chief  in  Sacramento,                                                               
California,  discovered this  in 2011,  perhaps. They  found this                                                               
and have  been promoting this  to other departments. It  has gone                                                               
through many other  states now.  There is no  cost to the general                                                               
fund. It puts  money back into municipal coffers.  It can relieve                                                               
the  tax burden  or it  can be  a supplement  to what  is already                                                               
budgeted. The  funds coming  back do  have to go  to the  care of                                                               
Medicaid patients.                                                                                                              
MR. ETHERIDGE said this may  help slow requests for equipment. It                                                               
doesn't  replace  the Code  Blue  Project  that many  departments                                                               
depend on for ambulances and  basic medical supplies. The City of                                                               
Juneau  anticipates that  this program  could bring  in $600,000.                                                               
The fire  chief in  Anchorage estimates that  this will  cover $4                                                               
million of their  costs. It is cheaper to do  an ambulance run in                                                               
Anchorage than in  Moose Pass. The previous fire  chief of Hoonah                                                               
told him  his training budget was  $1,200 for a year.  The influx                                                               
of  even  a few  thousand  dollars  would greatly  benefit  small                                                               
2:24:10 PM                                                                                                                    
CHAIR WILSON  asked what  paperwork is  needed to  comply because                                                               
Medicaid billing is not easy.                                                                                                   
MR. ETHERIDGE  said they have to  get a cost program  approved by                                                               
the   federal   government.   The  Fire   Chief's   Association's                                                               
contractor is willing  to help write that.  The local departments                                                               
have to fill out and submit  an annual cost report and submit the                                                               
data to DHSS.                                                                                                                   
SENATOR GIESSEL  asked if  it takes  12 to 18  months to  get the                                                               
program approved.                                                                                                               
MR. ETHERIDGE said  12 to 18 months can be  accurate. The company                                                               
his department  is working with  has done this several  times. It                                                               
would be on the shorter end of the timeframe.                                                                                   
SENATOR  VON  IMHOF said  the  California  fire chief  created  a                                                               
consulting firm to let everyone  know about the fabulous program.                                                               
If  everyone takes  advantage of  this  program that  has been  a                                                               
sleeping giant  for 30  years, it  could put  the brakes  on this                                                               
MR. ETHERIDGE said that is a  risk but any money into communities                                                               
would help  out. Even if  it went  away after the  first payment,                                                               
they are not out anything.                                                                                                      
2:26:48 PM                                                                                                                    
SENATOR VON  IMHOF said  a concern of  the Health  Care Blueprint                                                               
Committee that  she is part of  is bending the cost  of growth of                                                               
health  care. Simply  bringing in  new money  doesn't necessarily                                                               
bend the growth  of health care. It generally  expands it because                                                               
there are new areas to spend it  on. She asked if the fire chiefs                                                               
have talked about that.                                                                                                         
MR.  ETHERIDGE responded  that it  takes  good fiscal  management                                                               
from the department, knowing that the  funds could go away at any                                                               
time. They  need a tax  base to  support programs that  they have                                                               
built. Juneau has  a desperate need for  an additional ambulance.                                                               
If  they could  get the  funds for  one, it  would be  easier for                                                               
long-term planning. It takes careful fiscal management.                                                                         
SENATOR  GIESSEL  said  this  bill   is  talking  about  Medicaid                                                               
beneficiaries. To expand the  conversation to private businesses,                                                               
there  is a  large business  group in  Anchorage upset  about the                                                               
high cost of insurance, health  care, and medivacs in particular.                                                               
She related  that it cost  $17,000 to medivac someone  from Kenai                                                               
to Anchorage. Somebody  has to cover the Medicaid  costs that are                                                               
not fully  reimbursed. She  asked if those  costs are  shifted to                                                               
private insurance.                                                                                                              
2:29:22 PM                                                                                                                    
MR.  ETHERIDGE said  they have  to set  standard ambulance  fees,                                                               
whether it is medivac or  ambulance transport. They bill patients                                                               
the same amount. They  have to write off as bad  debt what is not                                                               
covered by Medicaid.                                                                                                            
2:30:13 PM                                                                                                                    
CHAIR WILSON opened public testimony on HB 176.                                                                                 
BRITTANY SMART,  Special Assistant to the  Mayor, Fairbanks North                                                               
Star  Borough,  supported  HB  176. She  said  in  the  Fairbanks                                                               
Borough, 30 percent of transport  patients are Medicaid patients.                                                               
In calendar year 2016, the  borough had $430,000 in uncompensated                                                               
costs that could be reimbursed through this program.                                                                            
2:31:50 PM                                                                                                                    
CHAIR WILSON closed public testimony on HB 176.                                                                                 
CHAIR WILSON asked how many states have similar programs.                                                                       
REPRESENTATIVE  WOOL said  there  are six  states  that have  the                                                               
program in  place and four  pending. Alaska will make  that five.                                                               
He  noted  that the  bill  has  support from  municipalities  and                                                               
transportation  providers.   They  didn't   hear  from   any  air                                                               
transport.  They   are  largely  private  and   contract  through                                                               
SENATOR GIESSEL hypothesized that  Ravn Air transports a Medicaid                                                               
beneficiary from Kenai  to Anchorage. They are going  to bill the                                                               
Kenai Peninsula Borough  and the borough is only going  to get 40                                                               
percent  reimbursed from  Medicaid. She  asked who  makes up  the                                                               
rest of the charge.                                                                                                             
2:34:03 PM                                                                                                                    
REPRESENTATIVE  WOOL said  from Chief  Etheridge's testimony,  it                                                               
sounds like  the provider pays  the contractor.  The municipality                                                               
is on the hook for the air transporter's costs.                                                                                 
SENATOR  MICCICHE said,  to put  it another  way, it  is the  EMS                                                               
agency with  jurisdiction for that particular  place. Whoever has                                                               
the   jurisdiction   takes  on   the   cost.   Sometimes  it   is                                                               
uncompensated with  no one to pay  and they are left  holding the                                                               
REPRESENTATIVE  WOOL said  some states  have private  ambulances,                                                               
but most of the ambulances and  EMS services in Alaska are run by                                                               
CHAIR WILSON said  the fiscal notes were  changed from "emergency                                                               
ground transport" to "emergency transport."  At a future time, he                                                               
would like to know if taking  out "ground" changed the numbers at                                                               
2:36:21 PM                                                                                                                    
CHAIR WILSON stated that he would hold HB 176 in committee.                                                                     

Document Name Date/Time Subjects
HB 176 - Legislation - Version U (FIN).PDF SHSS 3/26/2018 1:30:00 PM
HB 176
HB176 Sponsor Statement 3.1.18.pdf SHSS 3/26/2018 1:30:00 PM
HB 176
HB 176 - Explanation of Changes 3.1.18.pdf SHSS 3/26/2018 1:30:00 PM
HB 176
HB 176 Flow Chart - 3.1.18.pdf SHSS 3/26/2018 1:30:00 PM
HB 176
HB 176 -Fiscal Note - HB176CS(HSS)-DHSS-MAA-2-15-18.pdf SHSS 3/26/2018 1:30:00 PM
HB 176
HB 176 - Fiscal Note - HB176CS(HSS)-DHSS-HCMS-2-23-18.pdf SHSS 3/26/2018 1:30:00 PM
HB 176
HB176 Supporting Documents - LTRs of Support 3.1.18.pdf SHSS 3/26/2018 1:30:00 PM
HB 176
HB176 - Letter of Support - FNSB - 3.26.18.pdf SHSS 3/26/2018 1:30:00 PM
HB 176
hb176 Support AML.pdf SHSS 3/26/2018 1:30:00 PM
HB 176
SB 193 Version D.pdf SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Version D Sponsor Statement.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Version D Sectional.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Version D CMS Letter 1.11.18.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note DHSS DPA Field Svcs.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note Dept Admin - Cent Admin Svcs.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note DHSS DPA QC.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note DHSS DPA Work Svcs.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note DHSS Med Svcs Adult Dental.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note DHSS Medicaid Services.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note DHSS Medicaid Svcs BH.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note DLWD E&TS.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
Support Letter for SB 193.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Support M Coons.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Version D CMS Letter 1.11.18.pdf SHSS 3/23/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 WORKDRAFT CS 30-LS1349.J.pdf SHSS 3/23/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Explanation of Changes.pdf SHSS 3/23/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
Support Letter for SB 193 FGA.pdf SHSS 3/23/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
HB 215 CSHB215(FIN) Ver O.PDF SHSS 3/26/2018 1:30:00 PM
HB 215
HB 215 DHSS Slide Presentation 2-20-2018.pdf SHSS 3/26/2018 1:30:00 PM
HB 215
HB 215 FN 1_26_18.pdf SHSS 3/26/2018 1:30:00 PM
HB 215
HB 215 Additional Documents-Public Health Briefing Paper 2.20.2018.pdf SHSS 3/26/2018 1:30:00 PM
HB 215
HB 215 Explanation of changes Ver D to Ver O.PDF SHSS 3/26/2018 1:30:00 PM
HB 215
HB215 Sectional Analysis ver O 2.20.18.pdf SHSS 3/26/2018 1:30:00 PM
HB 215
HB 215 Letters of Support.pdf SHSS 3/26/2018 1:30:00 PM
HB 215
CSHB 215 Support - Ak Comm on Aging.pdf SHSS 3/26/2018 1:30:00 PM
HB 215
HB215 Sponsor Statement ver O 2.20.18.pdf SHSS 3/26/2018 1:30:00 PM
HB 215