Legislature(2003 - 2004)

03/17/2003 01:50 PM FIN

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
SENATE BILL NO. 78                                                                                                            
                                                                                                                                
     "An  Act  relating  to  an  optional  group  of  persons                                                                   
     eligible  for medical assistance  who require  treatment                                                                   
     for  breast  and  cervical   cancer;  relating  to  cost                                                                   
     sharing   by   those  recipients   under   the   medical                                                                   
     assistance  program;  and  providing  for  an  effective                                                                   
     date."                                                                                                                     
                                                                                                                                
JAQUELINE TUPOU,  STAFF, SENATOR  LYDA GREEN, SPONSOR,  spoke                                                                   
in support of the bill.  She explained  that the bill removes                                                                   
the  sunset provision  of the  2001  legislation and  ensures                                                                   
continued treatment for women  who have been participating in                                                                   
the Breast and Cervical Cancer  Care program.  She also noted                                                                   
that the bill  creates future certainty to those  persons who                                                                   
may be diagnosed with these ailments in the future.                                                                             
                                                                                                                                
Ms.  Tupou  continued  to  summarize   that  the  bill  gives                                                                   
authority  to the Department  of Health  and Social  Services                                                                   
(DHSS) to allow maximum cost sharing  as per the federal law.                                                                   
She  noted that  currently Alaska  was  imposing the  maximum                                                                   
cost  sharing.   She pointed  out that  statute contains  the                                                                   
word  "lesser", and  the  current legislation  states  future                                                                   
authority, allowing  submission of  an amended state  program                                                                   
should  the  federal  government  raise  the  level  of  cost                                                                   
sharing.                                                                                                                        
                                                                                                                                
Ms.  Tupou referred  to a  handout (copy  on file)  regarding                                                                   
poverty guidelines  pertaining to a specific  category of the                                                                   
Medicaid  program, allowing  for 250  percent of the  poverty                                                                   
level.  The guideline  for a family of three  is $46,950, and                                                                   
for a family of four, $56,575.                                                                                                  
                                                                                                                                
Co-Chair Harris referred to the  HESS fiscal note with a cost                                                                   
of $282 thousand  of general funds, to match  $680 of federal                                                                   
funds.  He also  pointed out that in FY 2009,  the cost would                                                                   
be nearly  double, projected at  $544 thousand.  He  asked if                                                                   
the program was optional under Medicaid.                                                                                        
                                                                                                                                
Ms. Tupou  contended that the  program was not  optional. She                                                                   
added that  the program  was initially  a screening  program,                                                                   
but that when women were diagnosed,  the program was extended                                                                   
to  close the  loop  between diagnosis  and  treatment.   She                                                                   
concluded  that the  program  is currently  required  through                                                                   
that legislation.  She read from  Public Law 106-354, enacted                                                                   
           th                                                                                                                   
by  the 106   Congress, speculating  that  it was  predicated                                                                   
upon participation in the diagnosis  program.  She maintained                                                                   
that because the State participates  in the diagnosis portion                                                                   
of the program, the treatment portion is also required.                                                                         
                                                                                                                                
Co-Chair Harris asked   whether    the   federal   government                                                                   
required  participation  in  the  diagnosis  portion  of  the                                                                   
program.                                                                                                                        
                                                                                                                                
ELMER LINDSTROM, SPECIAL ASSISTANT,  DEPARTMENT OF HEALTH AND                                                                   
SOCIAL SERVICES spoke  in support of the bill.   He clarified                                                                   
that the state's participation in the program was optional.                                                                     
                                                                                                                                
Co-Chair Harris referred  to the fiscal  note in  relation to                                                                   
the DHSS  budget and  the matching  of federal  dollars.   He                                                                   
asked  if the  estimate  for FY  09 of  $544  thousand was  a                                                                   
realistic figure, and what was driving the increase.                                                                            
                                                                                                                                
Mr. Lindstrom  stated  that the fiscal  note was  well within                                                                   
initial projections.   He  referred to page  2 of  the fiscal                                                                   
note, which indicated two reasons  for the increase in costs:                                                                   
1) a five percent annual increase  in total recipients and 2)                                                                   
an assumption  that expenditures in this category  would grow                                                                   
at a  rate of 10  percent per year,  similar to  the national                                                                   
average growth for Medicaid spending.                                                                                           
                                                                                                                                
Responding  to a comment  by Co-Chair  Harris, Mr.  Lindstrom                                                                   
referred to the package of bills  introduced last week at the                                                                   
request   of  the   Governor   directed   at  Medicaid   cost                                                                   
containment.   He also expressed the Governor's  enthusiastic                                                                   
support of SB 78.                                                                                                               
                                                                                                                                
Representative Croft MOVED to ADOPT Amendment #1:                                                                               
                                                                                                                                
                                                23-LS0592\A.1                                                                   
                                                   Lauterbach                                                                   
                                                                                                                                
                     A M E N D M E N T                                                                                      
                                                                                                                                
     OFFERED IN THE SENATE                                                                                                      
          TO:  SB 78                                                                                                            
                                                                                                                                
     Page 1, lines 2 - 3:                                                                                                       
         Delete "relating to cost sharing by those                                                                            
          recipients under the medical assistance program;"                                                                   
                                                                                                                                
     Page 1, line 8, through page 2, line 3:                                                                                    
          Delete all material.                                                                                                  
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 2, lines 22 - 28:                                                                                                     
          Delete all material.                                                                                                  
                                                                                                                                
     Renumber the following bill section accordingly.                                                                           
                                                                                                                                
Co-Chair Harris OBJECTED.                                                                                                       
                                                                                                                                
Representative Croft explained  that  the  amendment  deleted                                                                   
cost  sharing  language.    He   noted  his  discomfort  with                                                                   
specific cost  sharing language,  suggesting that it  was not                                                                   
appropriate,  and   possibly  not  legally  allowable.     He                                                                   
maintained that  the language sent  a "mixed message",  as it                                                                   
pertained to only a portion of the population.                                                                                  
                                                                                                                                
Ms. Tupou reiterated that the  category was at 250 percent of                                                                   
poverty  level,  and added  that  the category  contained  no                                                                   
asset test.   She maintained that the category  was therefore                                                                   
a special category.                                                                                                             
                                                                                                                                
Representative Stoltze  asked about the fiscal  impact of the                                                                   
amendment.   Mr. Lindstrom  stated that  the amendment  would                                                                   
not impact the current fiscal note.                                                                                             
                                                                                                                                
Ms.  Tupou  suggested  that  if in  the  future  the  federal                                                                   
government  allowed more  cost sharing,  the amendment  might                                                                   
have an impact.                                                                                                                 
                                                                                                                                
Responding  to a  question by  Co-Chair  Williams, Ms.  Tupou                                                                   
maintained that the amount of  the co-payment was minimal: $2                                                                   
for  prescription  drugs, and  a  maximum $200  for  hospital                                                                   
stay.                                                                                                                           
                                                                                                                                
Representative  Croft  asked  if  the  fiscal  note  was  not                                                                   
impacted by the  amendment since it could not  be implemented                                                                   
currently.                                                                                                                      
                                                                                                                                
Mr. Lindstrom  observed  that  the  language  in  SB  78  was                                                                   
similar to that authorizing the  Denali Kid Care Program.  He                                                                   
pointed  out the similarity  in that,  under current  federal                                                                   
law, additional  cost sharing  provisions were not  possible.                                                                   
He noted  that, in  the case  of Denali  Kid Care, the  state                                                                   
submitted  a failed petition  to the  federal government  for                                                                   
the authority  to add  cost sharing.   He confirmed  that, in                                                                   
this  program,   the  income  eligibility   is  significantly                                                                   
greater than in typical Medicaid programs.                                                                                      
                                                                                                                                
Mr. Lindstrom also indicated that  the legislature might want                                                                   
to  reiterate  the   idea  that  in  the  case   when  income                                                                   
eligibility  was relatively  high,  with federal  permission,                                                                   
the State policy might be to increase co-payments.                                                                              
                                                                                                                                
Co-Chair Williams asked if federal  changes were anticipated.                                                                   
Mr.  Lindstrom stated  that  he was  unaware  of any  pending                                                                   
changes, but noted that changes could occur quickly.                                                                            
                                                                                                                                
Ms.  Tupou noted  that the  bill  did give  authority to  the                                                                   
Department to increase amounts if federal law changes.                                                                          
                                                                                                                                
Representative  Stoltze  asked   about  the  Administration's                                                                   
position on the issue.                                                                                                          
                                                                                                                                
Mr. Lindstrom stated that they deferred to the legislature.                                                                     
                                                                                                                                
TAPE HFC 03 - 34, Side B                                                                                                      
                                                                                                                                
Representative  Croft suggested  that the federal  government                                                                   
rejected the  Denali Kid  Care waiver  because it targeted  a                                                                   
particular  population.   He maintained  that a  cost-sharing                                                                   
request for the  proposed program would also  be rejected for                                                                   
the same reason.   He also summarized that the  bill gave the                                                                   
Department  of  Health  and  Social  Services  permission  to                                                                   
charge an uncertain  amount at an uncertain  time to affected                                                                   
persons.   He suggested  that cost  sharing be examined  when                                                                   
and if  federal guidelines in  fact changed.  He  expressed a                                                                   
preference to send a clear message with the legislation.                                                                        
                                                                                                                                
A roll call vote was taken on the motion to adopt Amendment                                                                     
#1.                                                                                                                             
                                                                                                                                
IN FAVOR: Croft, Foster, Williams                                                                                               
OPPOSED: Hawker, Meyer, Stoltze, Chenault, Harris                                                                               
                                                                                                                                
Representatives Joule, Moses, and Whitaker were not present                                                                     
for the vote.                                                                                                                   
                                                                                                                                
The motion FAILED on a vote of 3 to 5.                                                                                          
                                                                                                                                
Representative Foster MOVED to report SB 78 out of Committee                                                                    
with the accompanying fiscal note.  There being no OBJECTION                                                                    
it was so ordered.                                                                                                              
                                                                                                                                
SB 78 was REPORTED out of Committee with "no recommendation"                                                                    
and with a previously published fiscal impact note:  HSS #1.                                                                    

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