SCS CSHB 393(HES): "An Act relating to managed care for recipients of medical assistance; and providing for an effective date."
00SENATE CS FOR CS FOR HOUSE BILL NO. 393(HES) 01 "An Act relating to managed care for recipients of medical assistance; and 02 providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. FINDINGS AND PURPOSE. The legislature finds that 05 (1) the Medicaid program has provided adequate health care for low income 06 individuals in the state since its enactment in Alaska in 1972; 07 (2) Medicaid program costs have increased an average of 13.9 percent a year 08 over the past five years, and the number of eligible individuals has grown from 57,251 in 09 1991 to 86,445 in fiscal year 1995 due to the addition of services and eligible groups by the 10 Congress and the Alaska State Legislature; 11 (3) Medicaid program management has evolved from a fee-for-service payment 12 structure to a point where, by 1995, 94 percent of the states include some type of managed 13 care model in at least one geographic area of their state; 14 (4) primary care case management offers an effective system of care, similar
01 to the existing fee-for-service environment, which can generate program savings and preserve 02 quality of care, and which has been successful in both urban and rural areas; and 03 (5) Alaska has many unique features due to the geography, weather, and wide 04 dispersion of population centers that challenge the ability to have successful managed care 05 systems in the state; however, the projected downturn in state revenue requires the state to 06 seek creative solutions in providing health care coverage for low-income persons at a reduced 07 cost in the future. 08 * Sec. 2. MANAGED CARE PROGRAM. (a) The Department of Health and Social 09 Services shall begin development of a managed care system for recipients of medical 10 assistance under AS 47.07 by designing and implementing no fewer than two innovative 11 managed care pilot projects by June 30, 1997. The projects must be in one or more 12 predominantly urban areas of the state that take into account the unique features of the project 13 areas and include a rural element, if feasible. The department shall involve the public and 14 affected consumers and providers of health care services in the selected project areas in the 15 development of the managed care system that will be used in the projects. 16 (b) Upon developing a system required under (a) of this section, the department shall 17 submit through the governor draft legislation, if necessary, that would provide for 18 implementation of the proposed system in two or more pilot project areas to the legislature 19 on the first day of the First Regular Session of the Twentieth Alaska State Legislature. 20 (c) The department, under this Act, may require that a recipient of medical assistance 21 under AS 47.07 must participate in a managed care system in order to remain eligible for 22 medical assistance under AS 47.07. This participation requirement may be based on 23 geographical, financial, social, medical, and other factors that the department determines are 24 relevant to the development and efficient management of the managed care system. 25 (d) The department, under this Act, may apply for waivers of federal law or for other 26 federal approval if federal approval is required in order to implement the pilot projects for the 27 managed care system developed under this section. 28 (e) Nothing in this section precludes the department from acting to effectively manage 29 costs through case management and other cost containment measures that are within the 30 department's statutory authority in order to assure the operation of the program within its 31 budget.
01 (f) In this section, "department" means the Department of Health and Social Services. 02 * Sec. 3. This Act takes effect immediately under AS 01.10.070(c).