Legislature(2013 - 2014)HOUSE FINANCE 519
03/28/2014 08:30 AM House FINANCE
| Audio | Topic |
|---|---|
| Start | |
| HB134 | |
| HB121 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 278 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 134 | TELECONFERENCED | |
| += | HB 121 | TELECONFERENCED | |
HOUSE BILL NO. 134
"An Act requiring Medicaid payment for scheduled unit
dose prescription drug packaging and dispensing
services for specified recipients."
8:37:21 AM
Co-Chair Stoltze discussed housekeeping.
Representative Costello pointed out to the committee a
letter from Jason Hooley, Special Assistant, Department of
Health and Social Services that addressed the fiscal note
(copy on file).
8:38:16 AM
WILLIAM STREUR, COMMISSIONER, DEPARTMENT OF HEALTH AND
SOCIAL SERVICES (via teleconference), summarized the
letter. He relayed that the requirement for the department
to pay for the delivery of the medisets on a weekly basis
had been eliminated. He shared that the delivery costs had
been a challenge for the department because they were
formidable; if the providers of medisets decided to expand
out into urban areas like Fairbanks or Juneau the costs
would be very large. By removing the requirement and
allowing for bi-weekly distribution the department was able
to take the cost of the service down to zero. He said that
the bill put in statute the requirement to continue to pay
for medisets. He spoke to the proven efficiency and
efficacy of medisets. He said that the program helped
patients maintain integrity by ensuring proper dosage of
medications.
8:41:28 AM
Co-Chair Austerman asked whether any expansion in dollar
value that the state could pay was included in the current
Medicaid budget.
Commissioner Streur replied yes. He noted that the growth
factor was built in and assumed in the fiscal note. He
believed that the growth could be sustained by the
department.
8:42:53 AM
Co-Chair Austerman asked if the regulations that controlled
mediset confined the places where it could be distributed.
He wondered if mediset was confined to Anchorage by
regulation or because of the operational cost of doing
business.
Commissioner Streur replied that there would need to be
enough of a market for the pharmacy to produce mediset
because it required an additional cost to the business. He
noted that some smaller pharmacies did provide the service
for a small fee or none at all. He believed that it was a
question on volume and the cost of setting up the
capabilities to do mass medisets.
8:44:42 AM
Co-Chair Austerman understood that the state and Medicaid
split the cost of the medisets 50/50.
Commissioner Streur replied that certain prescriptions were
covered at a higher percentage. The fiscal note accounted
for the departments acknowledgement that the bill.
8:45:39 AM
Representative Wilson asked if the bill would cover all
seniors with two or more prescriptions.
Commissioner Streur replied that it would cover anyone who
was eligible. The person had to have a requirement for a
mediset and had to be thoroughly vetted.
Representative Wilson understood that people who were not
on Medicaid would have to pay for the program themselves.
Commissioner Streur agreed.
8:46:53 AM
Vice-Chair Neuman asked how much the program was currently
costing the state.
Commissioner Streur deferred to the Director of Healthcare
Services.
MARGARET BRODIE, DIRECTOR, HEALTH CARE SERVICES, DEPARTMENT
OF HEALTH AND SOCIAL SERVICES (via teleconference), replied
that the state currently paid $375 thousand annually for
mediset packaging.
Vice-Chair Neuman asked if the fee was a fee that was
typically covered in nationwide dispensing fees.
Commissioner Streur replied no.
Vice-Chair Neuman surmised that the program would be unique
to Alaska. Commissioner Streur replied other states were
beginning to address the issue. Vice-Chair Neuman asked if
the department had the ability to manage the cost fees and
structures of the program. Commissioner Streur yes. Vice-
Chair Neuman concluded that if it were to be written in
statue the state would have the same ability. Commissioner
Streur said that the current bill version reinstated
management to the department. Vice-Chair Neuman queried the
current dispensing fee per month.
Ms. Brodie replied that the current dispensing fee per
person, per month was $12.12.
Vice-Chair Neuman asked what the mediset fee was per
prescription.
Commissioner Streur replied $5 per person, per month.
Vice-Chair Neuman expressed concern regarding expanding
healthcare costs.
Commissioner Streur countered that if the program would
save the state the additional costs caused by someone
improperly using medications.
Vice-Chair Neuman understood that by putting it into
statute, instead of regulation, the legislature would not
be able to reduce the cost of the program.
Commissioner Streur replied that the legislature could
potentially make cuts in the department's budget. He
believed that if the department was asked to make cuts,
medisets would not be a priority. He highlighted that the
way that the legislation was written did not change
anything that the department was currently doing.
8:52:33 AM
Representative Munoz understood that mediset was paid only
to certain pharmacies that reached a certain volume in
dispensing; the bill would open up payment to all
pharmacies.
Commissioner Streur replied that the bill did not speak to
the issue. He noted that the regulations required that 75
percent of prescriptions must be mediset before they would
qualify for the mediset fee. He relayed that the bill did
not speak to a minimum number or percentage.
Representative Munoz asked if the $5 fee remained for the
new pharmacies that were dispensing, in addition to the $12
fee.
Commissioner Streur reiterated that that was in regulation.
The bill did not speak to the issue.
8:54:23 AM
Co-Chair Austerman understood that there could be
restrictions on businesses based on the percentage of
mediset business it generated. Commissioner Streur replied
in the affirmative. Co-Chair Austerman asked whether the
regulation was being proposed or if was already active.
Commissioner Streur replied that it was under proposal. Co-
Chair Austerman queried any concerns held by the department
on the issue.
8:55:25 AM
Commissioner Streur stated that the department believed
that medisets were an important part of health and safety
for vulnerable adults and children; therefore, it was the
departments believe that they should be accessible on a
statewide basis to a wider variety of pharmacies. He
admitted that the rate structure needed further examination
before he could provide a conclusive answer. He said that
he would report back to the committee in order to clarify
further.
Co-Chair Austerman felt that the regulation would be a way
to control cost; only larger pharmacies in large
communities would benefit.
Representative Guttenberg shared that there were two
pharmacies in Fairbanks that provided medisets, but that
medisets were not their primary business. He said that the
75 percent limit would prevent some pharmacies from
expanding even marginally. He wondered if that had been the
intent of the regulation.
8:57:09 AM
Commissioner Streur thought that he needed to study the
intent of the regulation more deeply. He said that the
regulation was not restricting any pharmacy from dispensing
a mediset rather it would restrict a pharmacy from
receiving a mediset fee. He thought if the efficacy and
safety was apparent, it was incumbent of the state to look
to expanding mediset to the extent that it could.
Representative Guttenberg relayed that under the
description of a qualifying pharmacy, the last qualifier,
number 5:
"Delivering prescriptions using the most cost
effective method…"
Representative Guttenberg thought that pharmacies could be
using the most cost effective method while not charging the
least amount of money. He thought the language gave the
department a lot of authority for regulation.
Commissioner Streur stated that the language spoke only
with regard to the delivery of the medisets.
8:59:22 AM
Vice-Chair Neuman asked about the 75 percent rule. He
understood that the rule benefited smaller communities
because it would allow more pharmacies to participate in
the program. He asked whether the 75 percent rule had been
removed, and if so, why it was removed.
Commissioner Streur offered to provide the information at a
later date. He added that the 75 percent rule was already
in the proposed regulation, but was not yet in statute.
9:00:56 AM
Representative Costello understood that currently and
pharmacy that wanted to provide the service could, the
question was whether or not they would be reimbursed for
the service. She believed that the regulation review
process could be followed. She asserted that the bill was
intended to be a cost savings measure. She appreciated the
home setting as a less expensive solution to the rising
cost of medical care. A registered nurse dispensing the
medication was more costly to the state. She saw the bill
as a compassionate method to allow more individuals to
receive in-home care, surrounded by their family.
9:04:10 AM
Vice-Chair Neuman MOVED to REPORT CSHB 134 (FIN) out of
committee with individual recommendations and the
accompanying fiscal note. Co-Chair Stoltze OBJECTED for
discussion.
Vice-Chair Neuman appreciated the effects of the mediset
program even if having the medisets delivered did not
ensure that the medications would be taken correctly. He
expressed concern with the growing cost of healthcare in
the state. He believed that in 10 years the state's
Medicare costs would be $3 billion or higher. He feared
that the state would be unable to continue to pay for the
program in the future and believed that the costs would
need to be measured against other senior benefits when
creating future budget. He warned that the cost of
pharmaceuticals would be determined by the pharmaceutical
companies and not the state, which meant the state would
have trouble controlling the cost of the program.
9:08:05 AM
Representative Wilson pointed out Page 2, line 13, which
laid out the 5 eligibility standards. She understood that a
person living in their home would not be covered. She
believed that the program was a good idea but thought that
it should be open to all seniors and include all
pharmacies.
9:09:55 AM
Representative Guttenberg thought that the medisets could
inform paramedics on a scene as to which medications a
patient had, or had not, taken. He believed that the small
cost containment efforts could make a huge difference in
the big picture.
9:11:48 AM
Representative Gara shared his introduction to the mediset
program while visiting a senior center. He stressed that
the fiscal note could not reflect the savings to the state
from someone not having to be hospitalized because that
could not be predicted. He believed that Commissioner
Streur had worked harder than any other commissioner in the
state at trying to find ways to save money. He had faith
that the zero fiscal note would prove to be true.
9:14:09 AM
Representative Thompson thought that there should be
further discussion on the 75 percent rule. He said that
pharmacies in the smaller areas were providing the service
for zero cost.
Representative Costello replied that the 75 percent
requirement was in regulation and was currently under by
the commissioner. She said that the bill would put into
statute a program that was valuable to the citizens of
Alaska in terms of cost savings and quality of life. The
regulation being considered by the department was not a
part of the legislation.
9:16:59 AM
Representative Thompson thought that the 75 percent rule
would drive the business to one pharmacy. He reiterated
discomfort with the regulation.
Co-Chair Stoltze appreciated the process that the bill had
traveled through to its current iteration.
Co-Chair Stoltze WITHDREW his OBJECTION. There being NO
OBJECTION, it was so ordered.
CSHB 134 (HSS) was REPORTED out of committee with a "do
pass" recommendation and with one previously published zero
fiscal note: FN 1 (DHS).
9:21:09 AM
AT EASE
9:23:08 AM
RECONVENED
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 121 CS FIN Amendments 1-2 Gara.pdf |
HFIN 3/28/2014 8:30:00 AM |
HB 121 |
| HB 121 CS WORKDRAFT FIN version N.pdf |
HFIN 3/28/2014 8:30:00 AM |
HB 121 |