Legislature(2005 - 2006)CAPITOL 106
02/08/2005 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB82 | |
| HB105 | |
| HB106 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 82 | TELECONFERENCED | |
| *+ | HB 105 | TELECONFERENCED | |
| *+ | HB 106 | TELECONFERENCED | |
HB 105 - MEDICAID FOR ADULT DENTAL SERVICES [Contains discussion of HB 106.] 3:26:31 PM CHAIR WILSON announced that the next order of business would be HOUSE BILL NO. 105, "An Act relating to coverage for adult dental services under Medicaid; and providing for an effective date." REPRESENTATIVE SEATON moved to adopt the proposed committee substitute (CS) for HB 105, Version 24-GH1081\G, Mischel, 2/7/05, as the working document. There being no objection, Version G was before the committee. 3:27:37 PM JOEL GILBERTSON, Commissioner, Department of Health and Social Services (DHSS), explained that HB 105 and HB 106 are a combined effort to establish better senior care. The administration and the twenty-third legislature established the SeniorCare program. He said that together SeniorCare and the state have addressed the issue of high prescription costs by forming the multi-state prescription drug purchasing plan and establishing a senior information office. He reported that Alaska has a vibrant, growing senior population and that senior services need to grow alongside that population. He said that HB 105 is a proposal from Governor Murkowski, to strengthen oral health and dental services offered to low income seniors. COMMISSIONER GILBERTSON relayed that the administration has worked very constructively with the Alaska Mental Health Trust Authority on a collaborative project to focus on dental services. The current Medicaid coverage for adults, adults is defined as those over the age of 21, is restricted only to emergency dental services. Thus, seniors and adults covered by Medicaid have no access to oral health care outside of an emergency setting; emergency services include the requirement to remove immediate pain and acute infection. He said that the administration and the Alaska Mental Health Trust Authority perceive this as a "tremendous health care problem facing our state." Oral health care is an important piece of health care for individuals and the state needs to invest in preventative measures, he noted. He said that HB 105 allows state Medicaid coverage for preventative and restorative care. In order to provide immediate service, and to keep the proposed program stable as the state addresses the pent-up demand needs, the benefits are capped at $1,150 per person annually. The cap ensures that each year, over a period of two years, a senior could purchase one-half of a complete set of teeth. The services available at the $1,150 threshold would cover either: one exam, 4 bitewing radiographs, basic cleaning, 8 restorations and/or extractions; or one exam and an upper or lower full denture. The fiscal note estimates 41,000 adults will be eligible for the expanded Medicaid dental benefits. COMMISSIONER GILBERTSON relayed that the federal contribution through fiscal year (FY) 2011 will cover approximately 66 percent of the costs for those individuals eligible for 100 percent of federal reimbursement. The state general fund (GF) will constitute 25 percent and the Alaska Mental Health Trust Authority about 9 percent of the matching funds. It is anticipated that the program will be operational the last quarter of FY 06, so costs that year are calculated at approximately 25 percent of the FY 07 costs and adjusted higher to allow for pent up demand, he said. He noted, that over time the Alaska Mental Health Trust Authority commitment to funding the GF portion of the "Medicaid match" will diminish. 3:37:20 PM CHAIR WILSON said that when she visits the dentist, she receives more than four x-rays, and the proposed program only covers four bitewings x-rays. She asked if the participating dentists would be informed about the allowable number of x-rays. 3:38:28 PM JON SHERWOOD, Medical Assistant Administrator, Division of Finance & Management Services, Department of Health and Social Services (DHSS), relayed that under the HIPAA [Health Insurance Portability and Accountability Act] rules there is a requirement to ascertain how much of a benefit foreign authorizations have allowed, and essentially obtain the prior authorization and the approval to pay for the service. He relayed that non-electronic methods are also available to check on prior authorization status. 3:39:36 PM COMMISSIONER GILBERTSON added that the vast majority of providers require prior authorizations and that most of the transactions are electronic. However, the providers that do not use electronic interaction with the state use telephonic communication. 3:40:28 PM COMMISSIONER GILBERTSON, in response to Representative Seaton, relayed that the FY 06 fiscal note reflects the operating cost for one quarter. The pent up demand will take three years to alleviate, after which there will be a more traditional inflation factor for the program. The GF portion will increase at a higher rate because concurrently with the program growth there will be diminishing support from the Mental Health Trust, he said. 3:41:51 PM MR. SHERWOOD, in response to Representative Seaton, related that: The assumption in this fiscal note would be [that] approximately 66 percent of the cost would be federally funded. And that's a combination of the regular match rate and the match rate we would receive from ... [the] 100 percent federal match rate for services provided through tribal facilities, which would be a significant portion. 3:42:33 PM COMMISSIONER GILBERTSON related that the calculations for the fiscal note assumed the 50-50 match rate. 3:43:25 PM MR. SHERWOOD, in response to Representative McGuire, relayed that the subsection B of version G "refers to the ... base treatment, the treatment people are already eligible for; ... it says that the limits we impose, under the previous paragraph, don't apply to that emergency treatment of dental care, so we wouldn't somehow come in and inadvertently limit and restrict the care we are already offering for these individuals." 3:44:30 PM REPRESENTATIVE McGUIRE reiterated that the only difference between the original HB 105 and Version G is the definition of minimum treatment. She asked what the administration's reasoning was for the definition change. 3:44:56 PM MR. SHERWOOD said he did not know. 3:45:31 PM COMMISSIONER GILBERTSON, in response to Representative Seaton, related that the "access issue around dental services is a legitimate one" and that while many dentists take Medicaid patients, many do not. The Dental Association of Alaska has stated its reasons for refusing Medicaid, such as reimbursement issues, clients not showing for appointments, and the reluctance of clients to sign the provider agreement required for Medicaid providers. He said that the DHSS is addressing the association's issues with the Department of Law (DOL), in order to provide advisory guidance. He related his belief that the department has gone out of its way to make Medicaid a "good product," He stated that the state needs more providers and more dentists willing to take Medicaid, and offered his belief that the governor's proposal is the right thing to do and it tells seniors, "we care." 3:52:25 PM CHAIR WILSON said that one of the reasons many of the dentists complained about Medicaid patients was due to cancelled appointments, and the department should address that issue. 3:52:50 PM COMMISSIONER GILBERTSON noted that he would not speak as to the motivations of dentists to treat Medicaid patients, but there are a variety of reasons. He noted that the U.S. Senator Ted Stevens is very concerned about this problem and he has been "approping money" to support the dental health care system by developing dental health aides. 3:53:50 PM REPRESENTATIVE McGUIRE said that she would be interested in analyzing the provider agreement because it could be impacted legislatively. She related her belief that the federal government should consider tax write-offs for the providers who treat Medicaid patients, thus creating more incentive for those providers. 3:55:34 PM COMMISSIONER GILBERTSON related that he would explore that option, but warned that tax credit issues and their interaction with other aspects of reimbursement policies are complex. During the twenty-third legislative session, Senate Bill 41 was signed into law and mandated that the department must contract a third party to conduct audits under all Medicaid services. He noted that while the provider agreement may be a topic to discuss, the real issue is what is the agency doing to support providers and what are the providers doing to make sure they are increasing access to health care. He concluded that reimbursement issues should be responsive to providers; the supply and demand of health care should be assessed and addressed. 3:57:21 PM REPRESENTATIVE GARDNER said that Alaskan rural health care has practitioners that provide cleaning, exams, and basic fillings. She asked if the rural health care providers would be eligible to participate in the Medicaid program. 3:57:40 PM COMMISSIONER GILBERTSON said "yes," adding that the rural health care is a federal initiative through Indian Health Services (IHS) and the Alaska Native corporations, and the proposal plan is to use more extender services. The Alaska Native Tribal Health Consortium (ANTHC), alongside the Native corporations, is in the process of utilizing more mid-level professionals, who are the crux of the health care system in rural Alaska, he noted. 4:00:37 PM COMMISSIONER GILBERTSON, in response to Representative Seaton, said that the DHSS is currently providing the service for children, but there is no coverage for adults. The proposal would give adults the increased coverage that the children already receive, he noted. 4:01:45 PM MR. SHERWOOD, in response to Representative Seaton, related his belief that the DHSS fiscal note did not "factor in an unusual amount for transportation." 4:02:43 PM COMMISSIONER GILBERTSON added that the fiscal note should not have to factor in additional transportation costs, since Medicaid is the largest transportation purchaser in Alaska and any reimbursement of transportation services is done through the Medicaid program, so it is a larger leverage of federal dollars. 4:03:15 PM REPRESENTATIVE SEATON related the dentists who accept Medicaid patients would continue to service the ones they have, but will not take any new Medicaid patients. Under these circumstances, would any patient under the proposed program have to be transported out of the area? He asked the DHSS to report back to the committee with a response. [HB 105, Version G, was held over.]
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