Legislature(2001 - 2002)
04/11/2002 03:43 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HB 407-CERTIFICATE OF NEED PROGRAM CHAIR DYSON announced the first order of business, HOUSE BILL NO. 407, "An Act relating to the certificate of need program." Number 0110 REPRESENTATIVE KOHRING moved to adopt version 22-LS1389\P, Lauterbach, 4/11/02, as the work draft. There being no objection, Version P was before the committee. CHAIR DYSON offered his understanding that Version P is the same as Version O with [Representative Cissna's conceptual Amendment 1] that was adopted at the April 9 hearing. Number 0200 REPRESENTATIVE COGHILL moved to adopt Amendment 1, which read [original punctuation provided]: Page 7: Delete lines 1 - 4. Page 7, line 1: Insert: COMPREHENSIVE HEALTH PLAN; LIMITATIONS. The plan required under AS 47.05.010(b), enacted by sec. 11 of this Act, (1) It is not intended by the legislature to be updated periodically; (2) shall be prepared by the Department of Health and Social Services by January 1, 2003, and a copy of it shall be given by the department to the legislature by that date: and (3) shall be prepared by using staff and other resources of the department that are generally available to perform the duties of the department without an additional appropriation specifically designated for preparation of the plan or without an additional appropriation to fund indirect impact of existing personnel or resources." REPRESENTATIVE WILSON objected for purposes of discussion. Number 0220 REPRESENTATIVE COGHILL explained that Amendment 1 would add "relating to comprehensive health planning" to the title. Referring to the fact that the amendment to Version O at the April 9 hearing had been conceptual, he said: We adopted this by conceptual amendment, basically, and ... I wanted to look it over and ask legal drafting to look it over, and this is basically what [would] come back. And the only thing that we didn't look at was the date, and Representative Cissna had ... registered some concern about that. And I'm open to that discussion. But at this point, it would take the plan that's required and ... then put it in these three bullets, if you will. REPRESENTATIVE COGHILL noted that Amendment 1 [paragraph (1)] calls for a one-time plan; it is not intended to be updated periodically, which is in contrast to what is already in statute, to his recollection. [Under paragraph (2)] it would be prepared by [the Department of] Health and Social services, and the date would be 2003, as adopted [in the amendment to Version O at the previous hearing]. He indicated he wanted it to be very clear that this [plan is to be developed] within the resources of the Department of Health and Social Services, which paragraph (3) accomplishes. Number 0325 CHAIR DYSON asked whether Representative Cissna was in basic agreement with Representative Coghill's Amendment 1. REPRESENTATIVE CISSNA replied that she was in agreement, but had real concerns about the date. She indicated she'd requested a partial copy of the health plan dated June 1984; department personnel had informed her of what is in place that could be drawn on for a [future plan]. She stated that there are gaping holes [in the current state health plan]. She asked if the department could speak to this matter. She suggested that an understanding of the missing pieces would give members an idea of what is reasonable timing for using existing services. Number 0450 ELMER LINDSTROM, Deputy Commissioner, Department of Health and Social Services, told the committee he didn't believe the date to be a relevant matter because, briefly, "No money, no plan." He said the  report was the last one done by the department. He explained that rarely a week goes by in the department in which someone does not say, "I wish we had a comprehensive health plan.". If the department had the resources, it would have done a plan. In the absence of additional resources to develop a comprehensive plan, Mr. Lindstrom said he thought the plan would not be accomplished. Number 0519 REPRESENTATIVE CISSNA said she was uncertain about the date. She remarked, "I really care about Alaska and that we survive as a state in some kind of not-third-world category." Referencing the [old health plan] with its problems and the preceding overview presentation by the Alaska Suicide Prevention Council, she again emphasized the need for a plan. As for the bill, Representative Cissna said she sees "two perfectly wonderful sides," without a way to discern the right policy; she expressed doubt that the committee could arrive at good policy without any information, which is lacking in critical areas. For example, there is no health systems data; it doesn't exist. Number 0599 REPRESENTATIVE COGHILL pointed out that there will be a change in the administration [because the governor's term is up] and suggested that if this administration is going to say, "No way," it might be good to [extend the date to 2004]. He conveyed his inclination to allow the date to change to 2004 if the department is required to use existing resources. CHAIR DYSON offered his conviction that Alaska needs to do some comprehensive planning in mental health, senior care, health- service delivery in urban and rural areas, prenatal alcohol poisoning, child abuse, and alcohol abuse. He stated his intention of joining [Representative Cissna] in holding some interim hearings on this matter. He added that other bills in the committee, pertaining to planning, won't make it [through the legislative process this session]. He deferred to Representative Cissna with regard to the date. Number 0708 REPRESENTATIVE CISSNA said no area is as needing of effort as the medical health [planning] area. She pointed out that mental health does have a comprehensive plan, as do many areas. She added, "We really are just ragged in the fastest-growing sector of our economy, which is really pretty scary. And I agree with you: this summer, you're on. Let's go for 2004." CHAIR DYSON announced, "Let the record reflect that Representative Cissna moves that we amend Amendment 1, line 12, to January [1,] 2004." Number 0755 REPRESENTATIVE STEVENS objected, saying he didn't see the point of changing it back. He noted that this is just what was done at the last meeting - it was changed from 2004 to 2003. He said his concern at that time was that a lot is being asked to be done; however, it is not unreasonable to expect that this be done by 2003. He offered that if the premise is that things will be different in a new administration, why not simply consider this bill next year? CHAIR DYSON said the amendment from Representative Cissna had been presented suddenly on [April 9], and that perhaps it was acted upon with less than due diligence. He added: Several of us have had time to think about it some more. The reason we did a title change today was to make sure that Representative Cissna's amendment on Tuesday did not fail for lack of a broad enough title. ... But it is an amendment to a bill largely aimed ... on a different subject. So ... you could certainly argue that a comprehensive study belonged in a bill of its own, but the reason we're dealing with this one now is because [of] the interest in modifying the certificate of need that's come up this year. CHAIR DYSON acknowledged that Representative Cissna and others recognize that having better information and comprehensive planning would be a valuable component in evaluating CONs [certificates of need]. He expressed his belief that the bill's sponsor is interested in seeing the bill move forward this year. When these two subjects were linked, he said, the committee wound up dealing with the date. He offered his perception that the real issue is whether it is reasonable to expect - with very limited resources - to have a valuable product that is able to be accomplished by January. Number 0928 REPRESENTATIVE CISSNA expressed her view of a "complete tie" between an evaluation tool and the plan. She said, "I don't have the tools to make that decision, and I've asked the department, and they don't have the tools to make ... that decision." She said perhaps other members felt comfortable making [this decision], but she didn't. CHAIR DYSON said he would argue that this is why Representative Cissna's amendment carried. Number 0971 REPRESENTATIVE JOULE offered his understanding that when the amendment passed [on April 9] with the 2003 date, that was assuming an accompanying fiscal note; the 2004 date and the clarification that this will be done with existing resources is the difference between the two dates. He said, "This way, the bill moves forward without a fiscal note, giving the department 18 months to do something with its existing resources, as opposed to doing something in 6 months with no additional resources." He specified that he was speaking in favor of the amendment to Amendment 1 [to change the date to 2004]. CHAIR DYSON voiced his understanding the Representative Cissna's amendment [on April 9] called for the plan to be completed with existing resources and hadn't anticipated a fiscal note. He asked whether Representative Stevens maintained his objection to the amendment to [Amendment 1]. Number 1046 REPRESENTATIVE STEVENS said yes. He added that Alaska is facing enormous problems statewide such as the "salmon disaster." He noted that these problems need serious study, and [if the amendment to Amendment 1 failed] would be dealt with via a report to the legislature by January 2003. In response to Representative Cissna, he said he thought he would support the 2003 date, but indicated he wanted to hear more about it. REPRESENTATIVE CISSNA withdrew the amendment to Amendment 1. Number 1130 CHAIR DYSON asked if there was any objection to Amendment 1. Hearing no objection, he announced that Amendment 1 was adopted. MR. LINDSTROM, in response to Chair Dyson, said the department had prepared two fiscal notes, both dated 4/10/02. One is for $100,500 for health planning and facilities management, and the other, from the Division of Medical Assistance, is in the amount of $4.6 million, for Medicaid services. CHAIR DYSON observed that Representative Coghill had put before the committee a zero fiscal note. He requested an explanation. Number 1210 REPRESENTATIVE COGHILL called his zero fiscal note a "direct challenge to the administration's fiscal note." He said a lot has to do with how he figured the growth of the economy and the way some Medicaid reimbursements are calculated. He asked the committee to recognize that this will not have an actuarial impact on the state. He said he recognizes the department's concerns, but drew attention to words in the department's fiscal note such as may, if, expected, estimates, assumptions, and unknowns. CHAIR DYSON asked whether it is correct that even if the bill passes in its present form, there will be no impact until new facilities are built, in use, and impacting Medicaid rates and reimbursement rates. Number 1293 MR. LINDSTROM agreed, but pointed out that every fiscal note [from a department] is based on assumptions regarding "somebody doing something." The department's fiscal note is based on the best information the department has, he said, and on what the department believes is most likely to happen, based on the letters of interest and CON applications. In this case, however, the decisions of whether to build facilities will be independent business decisions that the state doesn't control. MR. LINDSTROM added that the committee has heard widely divergent testimony on the impacts of the bill. Some passionately believe [HB 407] is the best thing that could happen to health care in the state, while others believe it is the death knell for the health care infrastructure in many communities. Number 1346 MR. LINDSTROM noted that everyone believes this bill will have a significant impact; the department shares this opinion. He offered that the department could not provide members with certainty about the exact costs. He referenced his earlier testimony that a lack of data has hindered [more accurate] estimates. He stated, "There is ... rarely a bill that goes through the legislature where it is more abundantly clear that, yes, there will be a fiscal impact, and it will accrue to the Medicaid program because the Medicaid program insures one out of six Alaskans ... in this state." MR. LINDSTROM referenced an analysis done on behalf of the Tanana Valley Clinic by Information Insights, dated March 25, which ultimately concluded that over time the bill - at least under the assumptions given - would [result in] a savings to the Medicaid program. He added, "Nevertheless, this analysis provided by Tanana Valley Clinic indicated in the first year there would probably be an additional cost of $200,000 to the Medicaid program if one facility was built in Fairbanks." He expressed doubt that anyone knew for sure how many facilities would be built. "There is unanimity, Mr. Chairman, that this bill is going to have a fiscal impact," he concluded. CHAIR DYSON concurred, noting that members indeed had heard conflicting testimony, including testimony about other states. He announced his intention, out of respect for the department, to send the bill forward with all three fiscal notes. CHAIR DYSON called for an at-ease at 4:08 p.m. He called the meeting back to order at 4:09 p.m. Number 1450 CHAIR DYSON informed members that an objection for discussion purposes needed to be withdrawn to [Amendment 1]. REPRESENTATIVE WILSON withdrew her objection. CHAIR DYSON again asked whether there was any objection to Amendment 1. There being no objection, Amendment 1 was adopted. Number 1470 REPRESENTATIVE STEVENS asked about the multiple fiscal notes. CHAIR DYSON explained that it is within the purview of the Speaker [of the House] to decide [on a fiscal note]. The committee is providing the Speaker with a synthesis of the information it has received about the fiscal notes. Number 1505 REPRESENTATIVE COGHILL moved to report CSHB 407 [version 22- LS1389\P, Lauterbach, 4/11/02], as amended, out of committee with individual recommendations and the accompanying fiscal notes. REPRESENTATIVE KOHRING objected for discussion purposes. He said he wasn't comfortable including the three fiscal notes, and would prefer to adopt the zero fiscal note. He concurred with Representative Coghill and suggested overhead could be greatly offset, with a possible result of zero cost or at least much less cost than the department projects. REPRESENTATIVE KOHRING then withdrew his objection, saying although the legislation doesn't go as far as he would like, he wanted to move it forward. He reiterated that he didn't agree with the department's fiscal notes, which are higher than what he would expect. Number 1573 REPRESENTATIVE CISSNA objected to the motion, explaining that she believes the state isn't prepared to deal with some of the problems it is facing, and that the plan needs to be in place prior to making such choices. In response to Representative Stevens, she reiterated that she objected to making a choice without having the tools to do it. A roll call vote was taken. Representatives Dyson, Stevens, Kohring, Joule, Wilson, and Coghill voted to move CSHB 407 [version 22-LS1389\P, Lauterbach, 4/11/02, as amended] from committee. [Representative Cissna abstained.] Therefore, CSHB 407(HES) was moved out of the House Health, Education and Social Services Standing Committee by a vote of 6-0.